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Re: Decision on TNF
acroce203 #263728 01/23/14 05:47 PM
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Originally Posted By: acroce203
the price I have for Remicade is buying from a pharmacy. I guess the hospital may have to buy that and the cost might be different.

That's interesting - since Remicade is mixed and administered via IV infusion at infusion centers/hospitals, I can't imagine it could even be dispensed by a regular outpatient pharmacy.

As for ordering 3 months of Humira - most docs like to see people try it for 3 months or even 4, before deciding if it worked or not. Of course, some people (not many) have side effects or reactions severe enough to never take a 2nd dose; but many rheumies can offer a few free sample shots to get things rolling.


Jen, 42, happy partner of James and Moma to Evan, 14, & Lucy, 12.5 (Crohn's dx @ age 3; on Remicade since April 2010.) I take piroxicam, Flexeril, & Nucynta ER nightly. 3 anti-TNFs didn't pan out for me.

"Science is the father of knowledge, but opinion breeds ignorance." -- Hippocrates
Re: Decision on TNF
acroce203 #263733 01/23/14 07:06 PM
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This community is just wonderful. Filled with knowledgeable and caring people.

I have tried filling out all those forms, only to be told that I don't qualify. Either it's because I have insurance, or do not meet the financial criteria. I really only wanted assistance with the co-pay, which some of those organizations offer, but again, I don't qualify.

With regard to the pharmacy price, I hadn't thought about that,and my doctor didn't say anything. I'm not sure she is aware of the exact protocol for Remicade in this practice. She is fairly new to it, and out of NYC Special Surgery where everything can be done in-house. As far as trying the Humira, I wouldn't want to have any kind of reaction, which probably wouldn't happen, but then have two doses left which no one will take. That happened with me when I used the Enbrel. I had three doses left. Fortunately, I knew someone using it as well and gave it away. It would cost about 2800 or so for the three month supply. As I said there is a big difference between Humira and Remicade.

Will be calling the hospital to see if I can get additional information.

Again thanks for all the input it's making my decision a little easier.


Re: Decision on TNF
acroce203 #263750 01/24/14 05:17 AM
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I understand you wouldn't want to risk having a ton of leftover Humira. That scenario is exactly what happened to me with Enbrel - I had site reactions (which I now know is relatively common and can sometimes be overcome with Benadryl & patience) and switched to Humira after 3 injections, leaving me 9 that I literally could not give away - and I tried!! Same as you smile Sorry if I wasn't clear, what I was trying to say is if you tried Humira, maybe your doc could give you a few free samples as a start - I think that is common - and then if you had no issues you could order 3 months' supply.

Hopefully the hospital won't be coy about their contracted fees with Medicare...

Re: Decision on TNF
acroce203 #263757 01/24/14 02:09 PM
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Jen, what do you mean about the hospital being "coy" with the Medicare information? I am assuming from what I have read here that I can't bring in the Remicade from a pharmacy. Which, I think, means that there will be a drug charge along with the infusion charge. Hopefully, I can get some definitive answer.

If I can't, maybe the doctor can. Jumping through these hoops is just so much fun especially trying to squeeze it in between working etc.

Oh Well!

Re: Decision on TNF
acroce203 #263789 01/24/14 10:30 PM
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rheumys can get samples of humira pretty easily. I was offered samples at each visit when I as on it.

you can't get remicade from a pharmacy, thats correct.

you can call the hospital or infusion center where you would get it done and ask the cost. I don't know much about medicare, but is there a phone# you can call and ask about your cost share for the med and infusion?


Carrie
Small business owner, 53 / mother of 5, Fort Worth, Texas
Remicade, Seroquel, Folic Acid, MTX, gabapentin
Undifferented spondylopathy HLA-B27+ (onset 2007- DXed 2008) with associated uveitis, psoriasis
EPI and IBS - gastritis due to NSAIDs
Right Hip replacement 2017 with subsequent 4" heterotopic ossification (removed 2019)
Re: Decision on TNF
acroce203 #263797 01/24/14 11:43 PM
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Remicade is covered by part B meaning after your deductible you are responsible for a 20% copay. Your supplement should pickup most of that heres a primer:

http://www.janssenaccessone.com/pages/remicade/guide/medicare.jsp

Any of the other bios are under your part D and that is a real crap shoot. is something to keep in mind during open enrollment period (same with supplements) I'm not aware of any company assistance programs that provide copay assistance to medicare. That is pretty much prohibited by various regulations.

Re: Decision on TNF
SouthernMoss #263824 01/25/14 05:00 PM
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this right here gives info for assistance for those in medicare.

Originally Posted By: SouthernMoss
I don't know what your financial situation is, but according to the link below from the Medicare.gov site:

"Patients with prescription drug coverage, including being enrolled in a Medicare Prescription Drug Plan (Part D), who have difficulty accessing their Abbvie medications may be eligible for assistance by obtaining a Pharmaceutical Assistance Program (PAP)exception based on health-related expenditures and household income."

(Abbvie is the maker of Humira.)


http://www.medicare.gov/%28X%281%29S%28i...kieSupport=1#H]


Edit:
I didn't scroll far enough at first. There are 4 separate programs described on this page. Be sure to read all of them.


Carrie
Small business owner, 53 / mother of 5, Fort Worth, Texas
Remicade, Seroquel, Folic Acid, MTX, gabapentin
Undifferented spondylopathy HLA-B27+ (onset 2007- DXed 2008) with associated uveitis, psoriasis
EPI and IBS - gastritis due to NSAIDs
Right Hip replacement 2017 with subsequent 4" heterotopic ossification (removed 2019)
Re: Decision on TNF
acroce203 #263827 01/25/14 05:43 PM
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Can't tell you guys how much I appreciate all this information. I have tried the different prescription assistance plans, but I am not eligible either because of insurance or annual income. The programs stay as close to the poverty line as possible, which I am sure makes sense. It's too bad that there isn't some sort consideration for those not at that line, but could definitely use the help.

Economically, Remicade seems to make more sense. Hopefully, it'll do its job. With my co pay Humira will be about $800 per dose, which is a big nut to crack.

Re: Decision on TNF
acroce203 #263829 01/25/14 06:29 PM
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good luck acroce, keep us updated!

and YES< there is no real aide for the middle class in the assistance programs.


Carrie
Small business owner, 53 / mother of 5, Fort Worth, Texas
Remicade, Seroquel, Folic Acid, MTX, gabapentin
Undifferented spondylopathy HLA-B27+ (onset 2007- DXed 2008) with associated uveitis, psoriasis
EPI and IBS - gastritis due to NSAIDs
Right Hip replacement 2017 with subsequent 4" heterotopic ossification (removed 2019)
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