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How did you obtain BRINSUPRI?
It seems many on this forum are taking Brinsupri. Assuming you are on Medicare I would really appreciate hearing how you got it approved. I know it currently requires a PA (prior authorization from your Dr). So the question is which Insurance approved it? Which Part D plan?
I never signed up for Part D so I must do that NOW so that my Dr can submit a PA to them. Brinsupri is not on any formulary lists and doubtful that it will be in 2026. So selecting a Part D plan in hopes that they will approve it, is just a gamble. In my area I have Wellcare, Silver Script, Humana, Medicare Blue and Health Spring (used to be Cigna) to choose from. Did you have success with any of those?
One person suggested that they “have to approve it” if a PA is submitted and there are no other choices etc. but I have learned that is not true.
My Dr really wants me to try it for my serious situation. Any insight would be greatly appreciated.
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@drwholigan
At least this is how it went for me.
I am sure there are all kinds of different plans etc.
When my MD first told me about Brinsupri, if I'm remembering correctly, he said that I would need to be pre-approved for the drug. If interested, his nurse would complete the paperwork - I just had to sign off on it - so I agreed. Once approved, and I got the impression it had to do with the severity of your disease/symptoms, then you go through the process of insurance approval. From start to finish it took about a month from initial application to actually receiving the first prescription. The first call I got was from Lauren in the inLighten Support department letting me know my application was approved. I was told that Amber Specialty Pharmacy would be calling me to verify the insurance info they had been given and we'd talk about my co-pay. She also said I would get a call from one of their educators after I received the first packet of information to review it with me and answer any questions I had. Carrissa called the day I received the packet. She let me know that she would be following up every 6 months, I think but I could call at any time with questions. Lauren was the first one to mention the grant program in case I needed financial support to help with the cost.
A rep from Amber called soon after I spoke with Lauren to verify my insurance. He said he'd get back with me that day to let me know about the dollars and cents. And he did. He told me my monthly copay would be $1695.00. Yikes. I said no way................He did say, depending on your Medicare plan, if Medicare denied to pay then you're responsible for the full amount. I was thinking Medicare denied it with that sticker price, but he said that it wasn't denied, but that was still my part of the payment. When I told him I'd have to decline, he gave me the number to call The Assistance Fund to apply for a grant. Said it would only take a couple of hours to find out if I qualified. So, I did. And I qualified. It took less than 30 minutes. They pick up the total amount of your portion after insurance pays, so I will pay nothing until 12/26, at which time you have to reapply. I let inLighten know that I'd spoken to Amber and she was surprised that he gave me the TAF number. Either way, that was my process. It starts with the doctor and ends with the specialty pharmacy. I made a few calls but that was it. Hope this helps!
I tend to overexplain, so forgive the rambling.
Karen
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3 Reactions@marilynk Which pharmacy helps you pay for this?
@picartist they just said the pharmacy so I assumed Panther.
@drwholigan
Who is your speciality pharmacy?
Online search:
Yes, a specialty pharmacy can help pay for a specialty drug prescription by connecting you with financial assistance programs, such as co-pay assistance programs and manufacturer-sponsored programs. They will work with you to apply for these programs, help navigate the insurance process, and can apply any approved funds directly to your bill.
How specialty pharmacies help with costs
Navigating insurance: The pharmacy works with your insurance company to get the best coverage possible for your medication.
Applying for assistance: If there is still a cost gap, pharmacy staff will help you find and apply for financial aid from programs offered by drug manufacturers, foundations, or other organizations.
Tracking funds: Once you are approved for assistance, the pharmacy will help track the funds and apply them to your prescription at each refill.
Co-pay assistance: They can help you use co-pay savings cards to reduce your out-of-pocket costs.
Alternative options: If your insurance doesn't cover the medication, the pharmacy can help you and your doctor explore other options, such as generics, biosimilars, or making a case for an insurance exception.
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1 Reaction@11565lady
UNC Health Specialty Pharmacy
@irenea8 I have WellCare as part D coverage. They are covering part of it with PA but TAF the Assistance Fund is covering the bulk of it. My doctor and the Brinsupri company connected me with them.
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1 Reaction@kpger this was exactly my process. But I was told wrong that I was covered through Dec 26. Re enrollment starts Dec 3 for the 2026 year. I spoke to several people with extremely long wait times until I got the person who knew. I got something in the mail today reminding that re enrollment starts Dec 3.
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