Price of Your Biologic Treatment - US Residents

[xJillx]

To those in the US:

Just curious, what do you pay for your biologic treatment? I have been reading a lot of posts with people reporting co-pays of several hundred dollars and up! How can you afford this?

If you don't mind, can your provide the following:

Treatment:
Insurance/Provider:
Co-Pay:

I apologize in advanced if I have crossed the line and this is too personal/private of a question! I guess I just would like an idea of what I may be in for down the line. Thanks!

 

[Crohn'sFor Life]

Drug: Humira
Insurance: HMSA
copayment: $5

 

[xJillx]

Well, that is certainly a manageable price! Glad to hear it! That is actually less than I pay for my Lialda, whichis $30 per month, but I only pay $10 with the loyalty card.

Thanks for sharing.

 

[Lisa]

ok - hot off the internet...lol...I have the Empire Plan, United Healthcare....

I am on Remicade, every 8 weeks, 4 vials....


Prescription Drugs -
Billed Amount - $6,448.00
Network Discount $3,290.40
Applied to Deductable $0.00
Paid by Plan $3,157.60
Patient Responsibility - $0.00

And.....

D1*
Chemotherapy-
billed - $147.00
discount - $102.12
deductable - $0.00
paid by plan - $44.88

D1*
Prescription Drugs
billed - $1.43
discount - $0.06
deductable - $0.00
paid by plan $1.37

D1*
Prescription Drugs
billed - $1.25
discount - $0.68
deductable-$0.00
paid by plan- $0.57

KX*
Chemotherapy
billed - $704.00
discount - $502.04
deductable- $0.00
paid by plan - $201.96

Totals
billed - $853.68
discount - $604.90
deductable - $0.00
paid by plan - $248.78

And the biggie - Patient responsibility! $0.00

 

[bwightman]

Drug: Cimzia
Provider: BCBS of MA (high deductible plan)
Cost: $50 after deductible (I have no idea what it will be when my deductible resets in January...probably at least $1K/month until I hit the deductible again)

 

[Jessi]

Treatment: Remicade, every 8 weeks after 3 loading doses, 3 vials each time
Insurance/Provider: Self-pay, no insurance
Co-Pay: $1,400 per infusion - but, Johnson & Johnson pays for my remi for a whole year!

 

[xJillx]

Thanks guys for your responses!

@pasobuff - Wow! All I can say is 'wow'!

@bwightman - $50 isn't bad. But I sure hope it doesn't jump to $1,000 in January!

@Jessie - That is awesome that Johnson & Johnson is picking up the tab. Did it take a lot of leg work to get them to help?

 

[Jennifer]

Can't think of my current cost so I'll just do the one I knew from last year although I'm not taking Asacol anymore.

Treatment: Asacol and 6MP
Insurance: Medi-Cal
Co-pay/Cost to me: 0
Cost without insurance: $600/mo

Edit: Medi-Cal pays for everything be it doctor visits, tests and medication.

 

[xJillx]

@Crabby - I have heard you talking about Medi-Cal before. To be honest, it was the first time I heard of it. What a terrific program!

Thanks for sharing!

 

[Jessi]

@Jessie - That is awesome that Johnson & Johnson is picking up the tab. Did it take a lot of leg work to get them to help?

If you have insurance, but still struggle with the cost, you can fill out an application called Remistart which could qualify you for up to $550 toward each infusion.

If you do not have insurance, like me, you can fill out a different application called Patient Assistance Program Application. You and your doctor will each fill out a couple page, and then attach a copy of your most recent federal tax return. If you qualify, it's good for a year, then you can reapply each year after that. It wasn't difficult at all. :ycool:

 

[chrisnsteph1022]

Treatment: Cimzia
Insurance/Provider: UHC
Co-Pay: $100/month (same price I also pay for Apriso)

 

[Crohn's Mom]

Treatment: Cimzia
Insurance: UHC
Co-pay: $35 for 2 months worth

I'm thinking we better keep this insurance forever !

 

[effdee]

I think Remicade/Humira/Cimzia are in the ballpark of $6-8k per dose (that's what I remember seeing on the insurance statements).
Insurance: BlueCross BlueShield PPO
Co-pay: ~$70 for 2 doses of Cimzia, can't remember the co-pay for the others but it wasn't a ton, probably about the same.

 

[ThanksP]

Cimzia
Tricare
$1700 billed to insurance, $22 co pay for me

 

[ThanksP]

I think Remicade/Humira/Cimzia are in the ballpark of $6-8k per dose (that's what I remember seeing on the insurance statements).
Insurance: BlueCross BlueShield PPO
Co-pay: ~$70 for 2 doses of Cimzia, can't remember the co-pay for the others but it wasn't a ton, probably about the same.

If your insurance was getting billed $6k per month for Cimzia, someone was pocketing a large chunk of change.

 

[Jefferson]

Just looked at my BCBSM Explanation of Benefits from my last Remicade infusion on June 3: Total charge: $16,090.00; Amount approved by Blue Cross: $8137.16... your Balance: $0.00 <whew!!!>

This is for 750mg

 

[effdee]

If your insurance was getting billed $6k per month for Cimzia, someone was pocketing a large chunk of change.

Now that I think again, I don't remember seeing the price for it. I was assuming it was similar in price to Remicade/Humira as it's the same type of drug. I'm curious to know why there's such a difference in price, unless Remicade and Humira lowered in price as well since I stopped using them. Thanks for the response.

 

[joshw2011]

I have Tricare Prime
Have gotten Remicade in the past and Humira now.
Not sure the actual price, but I know other prescriptions the copay is 3 or 9, and I think it's the same for these too... All I know is it is very low compared to the actual cost the insurance pays lol

 

[lookame]

I'm on Molina which is government aided healthcare. Anyway it covers everything and I can have a copay UP TO $5 but it's not allowed to go over that. In turn I have to go through other cheaper therapy drugs to see if those work for me and I have to use generics unless the drug doesn't come in generic

I'm currently on lialda and 6mp
molina
drug costs: Lialda- $650 per months supply, 6mp $80 per months supply
copay: $2 for lialda only(based on the high cost of $650...I'll gladly pay the $2 lol)

The really nice thing is Molina covers the whole cost of doctors appointments, I do require a referral for specialists(unless I'm in the hospital and they determin it's required...then it's all good)

 

[chrisnsteph1022]

My retail price for Cimzia is $5182.97/month, but my copay is $90.

 

[ThanksP]

Wow, I'm shocked at the range of prices for the SAME drug.

ChrisnSteph, is that what your insurance actually pays for it or just the billed amount? I guess TriCare was getting a deal with me afterall LOL

 

[xJillx]

Wow, I'm shocked at the range of prices for the SAME drug.

I am shocked, too. However, I am happy to hear most aren't spending more than $100 per month. That helped alleviate some of my concern.

Thanks again to all for your responses!

 

[chrisnsteph1022]

I have no idea what they pay. That's just the retail cost when I look it up on their website (pharmacy stuff goes through CVS Caremark).

 

[scoutfinch]

Wow, I'm shocked at the range of prices for the SAME drug.

Keep in mind the cost also depends on the type of facility the drug is administered in. I believe hospitals typically charge more than a private doctor's office.

Also a factor is the dosage - a higher dosage would cost more, naturally.

Another factor is the type of network discounts your insurance company has negotiated with the provider.

 

[ThanksP]

I understand that, especially with Remicade since its administered in a hospital/office type setting.

But I was really shocked by the Cimzia. The range of cost for a one month supply is astounding to me. I guess the only viable reason would be the agreed upon price with the insurance company since it's usually administered at home, and the max dosage is 4 injections a month (or so my doc told me).

 

[lola99]

I don't take remicaid not yet anyway. I will be taking it if imuran doesn't work for me. But I notice on the medications i take now that the (insurance saved $) part the amount is always different. For entocort this month it was almost $1500 that my insurance saved me. I paid a $15.00 copay.