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Copay Assistance
I know that “times are tough”, financially. Let’s face it, these osteoporosis drugs are awfully expensive!! I had asked my doctor to look at the “economics” (I.e. cost) of the three anabolic drugs she suggested I could treat my osteoporosis with. I heard absolutely nothing back!
So I did my own homework with the singular drug she sent the prescription for. It turns out most of these drug manufacturers offer “copay assistance”. That is, they’ll pay all or some portion of your copay up to a certain cap/limit. And that copay counts toward your insurance deductible that may apply. You might be concerned about “qualifying” for this financial support. My experience was that the drug company (Radius, manufacturer of Tymlos) didn’t ask any financial questions. It took 5 minutes of my time and they’ll pay $7,550 toward my Tymlos copay annually while I’m on the medication. They provided me a “copay assistance” number that I provided my specialty pharmacy and viola! I got my prescription. It’s worth asking your drug manufacturer or specialty pharmacy about financial help! One other caveat, when I signed up they indicated they couldn’t offer copay assistance if I was getting “government assistance” (on Medicare or Medicaid). I hope this helps!
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Good information! Never leave money on the table if you qualify for anything.
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1 ReactionI switched to regular Medicare with a supplemental policy, not an Advantage plan and my Evenity injections are covered 100%. The commercial insurance I was on denied coverage as I had not had any previous failed Fosomax or other non-anabolic medication usage. I was lucky to be over 65 and could get on Medicare.
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2 Reactions@crstern I have Traditional Medicare, Parts A, B, and D. I pay the B part out of my social security and then I also purchased a supplemental policy. I’ve had Evenity for 12 months that was covered 100%. No pre authorization as Traditional Medicare either covers something or it doesn’t. I’ve also had 2 Reclast infusions. Both covered 100% by Medicare.
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1 Reaction@crstern
Isn't it infuriating that our medical professionals avoid the financial elements of a treatment?!
I am also on Medicare and have a very good secondary insurance. Which is why I didn't do a flat out faint when I received my bill from Oregon Health Science University. The facility cost, preliminary tests and doctor visit was over $100,000. Each month, on a twelve month treatment plan, the Evenity infusion was over $10,000.
I paid nothing. I am so grateful for our coverage. It allowed me to concentrate on the treatment. I had one side effect with Evenity; I gained eight pounds in the third month, and I've been unable to lose them (I know how to diet).
If anyone is not able to pay for a proposed treatment, see if your health facility has a Foundation. OHSU has one that financially helps people with the cost of treatment.
I can't fully evaluate the results of the Evenity treatment as my back is too crooked to lie down for a bone density test. The positives are that I haven't fractured anything for over a year and my back feels stronger. I took a Reclast injection after I was done with the twelve Evenity infusions. It will last a year.
My best to all going through osteoporosis.