Has anyone taken Biologics?

I took Dupixent, auto-injected at home since 11/2024. I have chronic asthma and ideopathic emphysema. My spouse injects me because when I do it, I bruise myself and sone of the serum leaks out. I took it every 2 weeks for nearly a year and then found the side effects very bothersome (achy joints—arthralgia) so we switched me to Nucala, once every 4 weeks.

They will mail it in its own styrofoam cooler and ice packs to your home or the pharmacy you designate for you to pick up or the specialty pharmacy. You do have to get your md to get it pre-authorized.

Since starting the biologics, I have not had any flareups of ny asthma/emphysema (used to have flare ups 1/6x/year for over 20 years and eosinophils >500 per blood tests). Once I hit the $3k out of pocket max for rx under my private insurance (which serves as my Medicare MediGap plan), I no longer have any copays for any Rx, including Nucala for the rest of this year.

I have started on Xolair and noticed an immediate reduction in itching: what a relief. On my insurance I pay for the first $2100 and then no more on meds for the rest of the year. Not bad in that I also take Repatha and Auvelity, both very expensive. I need to look my around for a part D that is more helpful but I doubt I will succeed.

@cynthiaefs If you got approved for all of those, your Part D is golden. I personally would not mess with it unless something changes. We have had to fight hard not only to get the more expensive meds, but to keep getting them each year.

@hopeful33250 - having to go to the ER for breathing treatment is a lot - expensive, a lot of time invested, and somewhat scary.

I also have been on mepolizumab (Nucala) for a few years now, and generally it's changed things radically. Till this year with an upper respiratory infection that made my asthma symptoms flare and was difficult to kick, the Nucala has keep me off the prednisone I was having to do 3-4 times per year, as I'd have a flare-up.

I now have to do a rinse with a steroid whenever I get the slightlest hint of anything upper respiratory coming on, and continue it for 2 weeks.

Is your next appointment with the pulmonologist soon? If not, have you gotten to update him with what you've experienced through your patient portal?

@sueinmn My D Plan has a maximum of $2100 before they cover everything else.
So I pay the $2100 reluctantly but them get covered for the rest if the year.
Biologics are the main problem. MAybe one day, insurance will cover them!!!!!!!

@lisalucier

I appreciate your post, Lisa. Is Nucala an injection you receive in the doctor's office, or is it self-administered at home? I would love to be off of Prednisone; it is so tiring and draining. You mentioned a steroid rinse. Could you tell me more about that?

My next appointment with the pulmonologist isn't until mid-November. Perhaps I will send a message through the patient portal to discuss starting a biologic sooner rather than later. I am impressed with how many people have described this as a game-changer. That sounds good to me.

@cynthiaefs Actually, insurance is covering many biologics, with strict limits and prior authorization. In my opinion, while frustrating to me as a patient, this is appropriate for a number of reasons.

First, biologics were developed for those situations where the "old standby" treatments don't work. So if an older, cheaper drug works, let's use it to help keep costs down.

Second, many biologics (and other new drugs) have limited data to show their effectiveness and safety over time when prescribed in the "real world" (clinical trials have a limited patient base & short time.)

Finally, if I take one biologic drug at a cost of $10,000-$15,000 per year, that effectively wipes out my entire insurance premium for the year. Someone else (other insureds, the insurance company, the government) is then on the hook for all of my other medical costs - office calls, lab tests, hospitalizations, PT, etc...No wonder medical costs are spinning out of control.

@hopeful33250 - mepolizumab (Nucala) is something I have to reorder monthly (they don't prescribe/dispense it in, say, in a 3-month supply). I keep it in our refrigerator (has to be kept there, but not much bigger than two decks of cards placed end to end), and I give myself the shot each month. It is an autopen, so you really don't see the needle at all - just this plastic thing. Easy to do. I've not noticed any side effects.

I was not big on being on prednisone, especially with only sleeping four hours nightly on it and having trouble blurting out things that I should really keep to myself to my family members. Not ideal for positivity and diplomacy, I guess.

The steroid rinse, which I've not yet used since it's not really cold and flu season, is budesonide. You mix it in a saline rinse bottle, which many people with allergies and asthma already have around and know how to use. You just add the nonrefrigerated liquid vial to the saline rinse bottle with the distilled water and saline, and then use it like a normal nasal rinse. My allergist just prescribed this to help stave off the very long-lasting colds and upper respiratory infections I seem to get every winter. So, here's to a better winter next year!

You do have to qualify for mepolizumab (Nucala), but it was not a problem for me to qualify. I had wanted to be on omalizumab (Xolair) for a long time, which my aunt in CA used and was lifechanging for her. She was certain I could talk my allergist into putting me on it. My allergist and I were both pretty sure it would indeed help me, but I never came close to qualifying. My IgE levels never hit the right number.

From my experience, I think it would be worth your while talking to your doctor about a biologic sooner rather than waiting till your appointment. You'd likely be in for a video chat or prerecorded video lesson on self-administration, but that should not be a big deal.

@cynthiaefs
This is to everyone on Medicare. The federal government sets a limit on how much we can be charged for prescriptions that are covered (this means on the formulary) by your drug insurance. This year it is $2100. It doesn’t matter how many prescriptions you have. If you have one or a dozen the cap on the entire set is $2100 (if your insurance covers them). So check every open enrollment season to make sure your insurance covers the drugs you need.

@cynthiaefs I take Xolair and it has made a huge difference. After I meet my deductible, Medicare B covers the cost.