Orencia Cost

[Fixby]

I have been taking Orencia infusions for several years. I have a Medicare Advantage plan. Until this year my Orencia has been covered under the medical portion of my insurance plan. This year, my insurance company moved it to the Pharmacy portion, putting me in the donut hole in the first month. This is creating a huge increas in my medicinr costs. Has anyone else had this change happen to them? My insurance co. told me that this is a Medicare change

[lornaisobel]

How much does orencia cost

[nomoreheels]

Hiya Fixby, welcome. Are you in the US? Here in the UK Orencia (& other biologics & biosimilars) is covered by a biologics register. Once we pass the requirements for needing biologics it's then that the funding of whichever one is applied for. We're not required to pay for them, or through medical insurance. The way the NHS is set up it's free at the point of use.

The NRAS (National Rheumatoid Arthritis Society) is a UK charity if you wondered why I asked if you're in the US. Whilst mostly the members here on this site are in the UK we do have some other members from the US so if anyone sees your post who is also on Orencia & is able to help they'll hopefully respond.

[Empress30 in reply to nomoreheels]

I'm from the US. I take orencia. I inject once a week. My insurance is very good but I have always had to pay for orencia. If get a three month supply it is a better deal. My husband makes too much on retirement! It is easier to see a Doctors here in the USA.

[nomoreheels in reply to Empress30]

Thanks Empress30. Hopefully Fixby reads this & your other replies, will find it helpful & respond.

[Mandalou]

Hi Fixby, , how are you doing?

Maybe if you renamed your post so the heading might immediately attract some of the Stateside users of the forum. As they would be best placed to answer your questions and give advice.

Though our disease is universal how it’s funded is very different from country to country.

Most here are from the UK but not all so as Nomoreheels explained hopefully someone will see your post and give you the benefit of their experience with insurance issues for their Biologics.

Very best of luck to you , as if needing Orencia isn’t a struggle enough for you in the first place but to have these funding issues to deal with too. Makes me feel very grateful for our system here.

Mx

[nomoreheels in reply to Mandalou]

Good idea Mand, changing the title to attract those in the US would be helpful.

[Empress30 in reply to Mandalou]

I take orencia too. It depends how much you household income is. We make too much in retirement to get it free. I am in the US.

[nomoreheels]

Following on from the suggestion from Mandalou (above) It's easy enough to change the title Fixby… at the bottom of your post on the same line as Reply click on More v & from the drop down box select Edit, that will take you back to the template of your post for you to amend the title.

[kellymomcars]

Morning Fixby. I'm in the US, and have also been figuring out how to pay for these drugs when insurance changes. Here's what I've learned... The manufacturers of these high priced drugs normally offer copay help. The information can be found on their websites. Look for something that says " You could pay as little as $5" for more information. In addition to that, you can also apply with the manufacturer for more help under a Patient Assistance Program (PAP). You may get the drug sent to you direct from the manufacturer, not through your pharmacy. Ask your doctor for help. There are requirements for qualifying, and it takes a few months to get an answer. And you have to qualify every year. Its a pain, but worth it at a cost of $3000-$6000 per shot. I'm not on Medicare advantage, so I don't know if that creates a problem qualufying. Your doctor might be able to administer some salesman samples in the meantime, so you don't lose what you've gained. As another option, Cimzia is still covered under medical (not prescription) last I heard. It's an exhausting game, isn't it?

[nomoreheels in reply to kellymomcars]

Thanks for this info KMC. I hope it helps Fixby. Having some understanding now of what is needed to be put in place when you're not likely to be at your best makes me appreciate the system we have. Even if sometimes we have to jump through hoops to qualify for biologics the funding of whichever is recommended is rarely refused if the need is genuine & let's face it the process wouldn't be initiated if it wasn't. Then having someone doing all the admin on our behalf, we are very fortunate.

[kellymomcars in reply to nomoreheels]

There are definite pros and cons to both ways. I really appreciate and envy the NHS system of being able to have services, procedures and medicine approved and paid for. I do, however, appreciate that I have access to many different doctors and normally in a timely fashion--I can not fathom having to wait months to see a doctor when a person is in pain. I imagine that with both systems of health care, one needs to have the ability to understand how to get things done, and have the fortitude to get it done.

[nomoreheels in reply to kellymomcars]

I can only go from personal experience of course but in my GP Practice for example, if there are no GP appointments remaining on the day (some, usually a couple, appointment times on the day are held back at the beginning & end of surgery for such cases) & in urgent need we have an Advanced Nurse Practitioner/Paramedic who will see you the same day. With RD nurses the helpline is there & if needed will advise or see you. You may not see a Rheumy but they have direct contact with one or another if they aren’t in a position to help. That has only been necessary once for me when they couldn’t make the decision for me to come off a med & I’d to wait until my next Rheumy appointment. This is only my experience of course, I dare say others aren't as fortunate. Of course there are flaws, I noticed significant ones when I returned to the UK from living abroad for 11 years, but all in all it's not the worst system ever.

[Empress30]

What was your cost increase?