HI, All. Forgive me if this already was covered elsewhere.
Briefly, I was prescribed Horizant. At the time of the Rx, the "sleep expert" neurologist noted that it was very expensive and likely not covered by health insurance.
The cost of a 30 day supply at my local pharmacy was $450, none of which was covered by my insurance. I paid hoping it would work. But it did not. The Rx was not refilled
Meanwhile, I surfed on-line and found that others had noted the high cost of Horizant and that, even if it had worked for them, they had discontinued same due to the cost. I surfed further.
I visited the manufacturer's website. horizant.com/ At that website is a link to information for "Patients." horizant.com/phn Subject to some exceptions, persons residing in the United States could get a 30 day supply of Horizant--at either dosage (300 mg; 600 mg)--for $55.00, and some might pay as little as $0.00! I called their authorized pharmacy and spoke at length with a representative and confirmed what I had read.
I am not endorsing Horizant. And cannot vouch for whether or not the on-line pharmacy will, in fact, timely fill the Rx for the published prices. (I have read some online comments from folks who were dissatisfied with their experience). But for those interested in an alternative venue for purchasing Horizant at a low[er] cost, it might be worth exploring.
Oh: When I mentioned this to my now former "sleep expert" neurologist, his indifference was matched only by his apparent lack of knowledge of Dopamine Agonist Withdrawal Syndrome.
I did not explore the exception for the $0.00 cost; perhaps the 65 age limit is for that?
I confirmed my circumstance when I spoke with their representative at substantial length. I informed them that I was well-passed 65, that I had health insurance, that I was not on welfare, etc. When I spoke with their representative, they said that the only exception for the $55 per month was in the case of a person on Medicaid.
I cannot vouch for the details beyond the foregoing. However, I do recall what I perceived to be the lack of patience (indignity for questioning their website?) of the representative when I questioned how the advertised price could be possible for a person such as myself. They left no doubt in my mind that I was eligible. Beyond that, I cannot say.
Supplement: I just found my (typically) lengthy and (extremely) detailed Memorandum of My Telephone Conversation. I am not sure if I am allowed to upload same, but it confirms the substance of my initial post and has all that any person ever might need to know about how to fill an Rx for Horizant for $55 per month directly from their on-line pharmacy (Arbor Patient Care a/k/a Truax). Should anyone be interested, I can paste/cut relevant portions.
Hi, again, SueJohnson. Such is life in the 21st Century! Not surprised at all. My MemTelCon is dated in October 2022. Unrelated, well maybe not, but perhaps this may offers some solace:
While trying to make an appointment with either of two sleep expert neurologists recommended by my new general practice doctor, the first one clearly and unequivocally informed me that they had an available appointment at the preferred location. I said that I would check with the other sleep expert to see if I could see them sooner. The first neurologist said that would be fine. After speaking with the second recommended neurologist, I decided that the first would be better.
Oddly, when I called the first neurologist again to say that I would like to schedule an appointment with them as earlier discussed, they not only denied ever speaking with me before, but told me that they never would schedule an appointment at the location indicated because they simply had nothing to do with that facility!
No, I had not made a call to the incorrect location. Nor had I imagined things.
I am in the United States and am getting my Horizant through Truax. I am under 65 now, but fear what might happen once I reach that age. Will they drop me?
I finally got around to checking this out. If you go to their website at horizant.com/savings under Terms and Conditions it says "Patient not eligible if prescriptions are paid in part or full by any state or federally funded programs, including but not limited to Medicare, Medigap, VA, DOD, or Tricare. I suppose it is possible that if you don't submit a claim under medicare it would cover it but you said it wouldn't be covered on medicaid, and medicaid is listed along with Medicare.
I am now taking pregabalin, so I haven't followed-up further on this issue. From memory, however (if necessary, I can upload the literal text of my memorandum of telephone conversation), I expressly asked about whether my enrollment in Medicare and in private Health Insurance might preclude my participation.
The person with whom I spoke got impatient at my repeated requests to confirm what she already has assured me: "I said Medicaid, not Medicare. We don't care if you are on Medicare, only Medicaid." In this regard...
I am on Medicare A (Hospital); and have private Health Insurance that covers Rx's. I am not on Medicare B (Doctors) nor Medicare C (Rx's). Nor am I on Medicaid.
Part of the confusion may be due to the two different discount programs, offered by the same pharmaceutical company, at the same time, on the same website! The one has to do with $0.00 cost for Horizant; the other has to do with substantially discounted costs for Horizant. I was told that, though I was not eligible for the $0.00 cost option, "everyone" except those on Medicaid is fully eligible for the discounted option (then I believe @ $55.00 for 30 day supply).
Now, now, perhaps uninformed or misinformed, but she didn't appear to be ignorant. In any event, the issue is moot. Let's agree to disagree as they say. Be well.
Good morning, LanaCSR, and thank you for your question. I only can answer based on my telephone conversation with their representative around October 2022, following my review of the information that had been posted online. Based upon same--and with the understanding that I never pursued and cannot speak officially on behalf of Truax or any person other than myself--my understanding is that, so long as you are not on Medicaid (not Medicare) you will remain eligible for at least the substantially discounted price (v. $0.00).
You may be aware, but for any other interested persons who may not be, my understanding is that: (1) in the US, Medicaid is a health-care benefit, provided at the State level, whereby indigent persons of any age may obtain health care at a reduced cost, regardless of whether or not they also are "on" Medicare; but (2) Medicare is a health-care benefit, provided at the Federal level, whereby any and all persons over a certain age (in my case: 65), who contributed to the Medicare health-care system, may obtain health-care at a reduced cost.
I informed the person with whom I spoke that I was over 65, that I was covered by Medicare "Part A" (Hospital), that I had my own health-care insurance which did not cover the cost of Horizant, and other information. Her response (substantially paraphrased since I have not yet had my coffee): "So long as you are not on Medicaid--M E D I C A I D--you are eligible for the discounted rate of $55. per 30 day supply, regardless of whether for 300 or 600 mg. Further, if you order a three month supply, there is no delivery charge. We do not care if you are on Medicare, nor whether you have health insurance."
Unfortunately, SueJohnson was informed otherwise when she spoke with a representative of the same company. I can only speak on my experience. Again, if permitted or of further interest, I can either attach or cut-and-paste a lengthy memorandum of my telephone conversation with their representative.
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