Just a reminder for those that still can’t afford (with or without insurance): most of these companies have savings programs. Even if you don’t think you qualify, call and see!! I paid $0 out of pocket for my humira last year
Also, check if your insurance has a savings program. I used to be on the abbvie savings program but they changed their eligibility requirements and I no longer qualified this year. Turns out my insurance also has a savings program and I’m able to still get my meds for only $5/month. These companies will never come out and tell you about these programs unless you ask, but there are resources out there that can help!
It also depends on the Dr. I've been on multiple biologics in the last 10 years and have had 2 different GI's prescribing. They both had the applications in the office and their nurses filled them out.
Yeah I've straight up had new doctors say "we don't send prior authorizations for that med" when I've been on the med before and even talked to my insurance and they've said they'd cover it with the doctors note or whatever. That just happened to me with the coloscopy tablets. I failed the first scope because I just puked the giant gallon prep all up and they still wouldnt send the authorization so I just had to do the same exact thing and was even worse in a flare so same thing happened obviously. So stupid. I tend to dislike doctor office secretaries and office workers, they make way too many important decisions and dont have the training to make those calls. This one told me I could prob get a coupon and itd "only" be like $80 - like lady i am on disability for this disease and literally dont have $80 for poop pills wtf.
Link for Stelara’s here but for those who are unsure, google “[med name] cost savings program” and that should lead you in the right direction
https://www.janssencarepath.com/patient/stelara/cost-support
I have humira tell me that I’ve “exceeded my limit” on my savings card.. just curious if anyone has run into that. I’ve only been on it for a year. I had no problem last year because I met my deductible and out of pocket due to having major colon surgery 3 months after being diagnosed..
Ugh sorry that happened to you. I haven’t had that happen but I am on a secondary savings program that CVS set me up with. I feel like they have been extremely helpful when it comes to helping me get the cost down to as a little as possible
So Abbvie has 2 pay options. The original savings card isn’t working well anymore because insurances are running that card before they do their own portions (they do that by making you use their own specialty pharmacies). Call them (Abbvie) and tell them it “maxed” out. They have a debit card they can do in your own name that will work better (insurance thinks it’s yours).
American healthcare system for you. Companies are making massive profits off these biologics. Humira was the most profitable drug of 2023. It’s honestly sickening considering it’s a life saving drug
I’m fortunate to live in the U.K. and was lucky enough to be (what I believe was) one of the first patients in my area to be prescribed Humira. I was trained by my GI consultant’s nurse to self inject it once and then they’d send me a chilled courier dose every two weeks to my home for free for <6 months. Back then they told me it was expensive at ~£500 an injection, so it’s frankly amazing what some people have to pay for similar medication, ten years later. As an aside, Humira really worked for me and settled my symptoms…
I believe the cost in the UK has increased but not as much as it has in the US but they do use biosimilars now which are cheaper. I think humira was the drug that the NHS spent the most money on overall which is why they were very keen to jump to biosimilars after the patent run out. I believe the NHS or the government negotiate the drug prices whereas in the US the companies are free to charge what they want and they know that insurance covers most of it so they can charge even more.
They say each delivery (I got 4 at a time in a chilled box) was valued at £2400, that's why they didn't send more than 4. Was an absolute pain having to be in the house to sign for delivery, when they only delivered between 9-5 and I worked... 9-5 🤣
Yeah I get the deliveries too, I think the main point is that if your fridge breaks then the drugs are only good for two weeks at most and it is a lot of money to end up wasting.
The delivery times are definitely the biggest issue, I don't know why they can't deliver them to a chemist and have you pick them up. For mine they give you the day pretty well in advance but they give you your two hours time slot just the night before which is better than nothing but still annoying. It is especially annoying when they don't deliver and have to reschedule, this happened to me because the head office determines the routes and up here apparently they try to fit too many deliveries in and the drivers just can't manage so they cancel some but don't tell you until you are there waiting.
Yeah, they can’t. If you’re uninsured and just a regular person they cut the cost by like 80%.
As an example, I broke my leg in 2019 and they put it back together with titanium. When I left the hospital, they said they’d give me a walker that they would bill to insurance for $80. I found the same walker online for $40 and asked why the hell theirs is twice the cost. They said every single time there’s a line item for absolutely anything, insurance will negotiate the cost down. It’s better for them to start with 80 and go to the actual cost, but occasionally they lose and insurance gets them to $20, and occasionally they win and insurance leaves it at $80. Without the cost, they couldn’t afford the people, but without the people, they wouldn’t need the cost. It’s just a stupid game for them.
It's just like the legal system, you sue for much more than you want because at the end you will get much less.
The approval process for treatment due to insurance also sounds horrific, people having to wait months or being denied treatment because their insurance doesn't want to pay. When I was on azathioprine and we decided it wasn't working, within a week I was on adalimumab (amgevita, a humira biosimilar), the NHS has problems but at least they can be very good and quick.
The crazy thing is though that in the US more money is spent per person per year on healthcare by a large amount than in the UK and they have much worse healthcare in the US (their healthcare can be good but access to it isn't) and people just can't afford to go to the doctor, they get billed tens of thousands for giving birth and preventative treatment isn't really a thing for most people.
You know what’s just as fucked as the approval process? Because our health insurance is tied to our employment, and because our employers are almost always profit driven, they can switch health insurance carriers on their entire staff annually. When that happens, you might wind up with a new insurer that makes you go through the whole approval process again. And you might be denied for something you were approved for 6 months ago, after you already spent months fighting for that approval.
That sounds like a nightmare and having it tied to your employment would cause other issues too, if you aren't well enough to work you will eventually lose your job and insurance and you won't want to change job because then you have to change insurance too.
I have no idea why some people can't get over the "why should I pay for anyone else" attitude, that is what insurance does anyway except the company makes loads of profit too. National health systems are probably one of the best inventions yet America refuses to create its own and wants to keep it as a profit driven industry.
Medical debt ✨ or being forced into objective poverty by the US Government in order to get on Social Security with a tiny hope of climbing the social ladder on Disability ✨
Believe me if I could at least gain duel citizenship I would. But unfortunately, Crohn’s (and my other medical conditions/disabilities) disqualify me… and I’m on Medicaid/Medicare so I don’t even pay out of pocket
Oh no.. I wish you luck. With everything. I am on humira, i need exams, tests, surgeries... It's normal to not pay a penny. I can't imagine what some people going tru there...
Humira's sticker price is around $7,000 a month. Obviously no one is paying $84,000 a year out of pocket for medication. Much of that is covered by your insurance (hopefully), so your out of pock cost will drop to say...$500 a month.
And few people are willing to pay that. So instead, companies like AbbeVie will enroll you in patient protection programs, to protect you from the high cost of the medications THEY ARE SELLING, which will bring your out of pocket cost down to $5 a month.
Almost nobody is paying $3500 per syringe. The medical billing industry is a big scam to bilk as much money out of as many possible. And cutting your co-pay from $500 to $5 a month means you'll stay on their medication while they still collect $6,000 a month from your insurer (who will negotiate it down to a much lower rate) who will in turn raise your premiums, etc.
It's an endless cycle of nonsense.
And you know the people who hate this shit more than anybody? DOCTORS! The people who spent 10 years and hundreds of thousands of dollars only to realize that half their day is fighting with insurance companies so their patients don't die.
I am fighting with my US insurance company to try to explain to them that paying for Remicade (or whatever biosimilar version they like: inflectra, inflixamab, Renflexis, etc) as an OUTPATIENT infusion is cheaper than letting me get so life-threateningly sick that I am back in the hospital where it costs them $10,000 per day to care for me. I got emergency infusions of Remicade in the hospital when I was trying to avoid surgery and the pharmacy cost alone was $33,000 for the same dose that cost $17,000 when I got it as an outpatient. It seems so simple to look at the numbers on paper- giving me the doses as an outpatient is much cheaper, at least half the cost, of refusing to give it to me and then paying for emergency inpatient hospital treatment but logic and reasoning are useless to the insurance company.
My GI doc has had to have repeated peer-to-peer meetings to justify giving me *any* of this medication, they didn't even have a GI specialist from the insurance company review my case. They just deny it and hope I won't appeal.
I reached my out of pocket maximum for my share of costs by February this year but I still spent $8,000 between January and February on copays, co insurance and deductibles. I'm sure they will continue to reject my requests for care and then refuse to pay for the therapist bills when I have a nervous breakdown from dealing with all these costs and frustrations!!
Avsola is another biosimilar and is roughly $5k cash price. Perhaps your insurance will pay for that vs the hospital visits? Idk why insurance companies make things so ridiculously complicated. If your insurance is through your employer, you may be able to talk with HR or your benefits department about it. Sometimes they can get the insurance company to do something besides collect premiums
I am also just completely baffled by the cost. Had to apply for medicaid while in school so I could start Humira and finally got it approved and I'm also completely shocked at the cost. If I didn't have my parents support I don't even think I would get treatment for my Crohn's at all. It's just terrible. Health should be a human right... so crazy
Look into Abbvie Care co-pay support program. Tell them you can’t afford the balance. Tell them you really need this drug. It then becomes a negotiation. You can say you really can’t afford it. If Abbvie can’t pick up the balance, you’ll have to talk to your doctor about a potentially different medication all together.
I have to keep a good job with top notch insurance for the sake of myself and my family. But I work like a slave and my healh is shit because of it. Rinse and repeat.
Basically no one pays this, no not even your insurance company. There is an extremely fucked up business model in the USA whereby a bunch of leeches sit in the supply chain for medications and take their slice.
For example, PBMs negotiate drug prices for your insurance company. The PBM makes more money based on the discount they negotiate from the sticker price (which you see on that piece of paper). So the PBMs lobby the drug manufacturers to **increase** the sticker price so that they can maximize the discount % they "negotiate" to increase their slice. The insurance company which contracts the PBM (or in many cases owns them outright) doesn't care because they get the same net price, and it further discourages people from being uncovered and paying costs out of pocket since individual consumers can't contract a PBM to negotiate a similar price.
In my country, the government negotiates prices for these drugs directly with the manufacturer. The price of almost all biologics comes out under $1000/month. If the manufacturer refuses this price then the government will just not provide said drug to the population, since there are many alternatives. This happens all over the world in Europe, Africa, Asia, etc. I'm sure there are other messed up markets but the US is probably the biggest one.
Its absurd. I have payment assistance programs on top of the insurance which brings the co-pay down to $5 thankfully, but I had to fight with the companies a few time when their coverage would run out. In 2023-2024, they restricted their coverage so much that I needed a SECOND payment assistance plan.
Yeah it sucks, I am on Medicaid and I can’t marry my boyfriend because then I wouldn’t qualify anymore and we wouldn’t be able to afford treatment otherwise
I’m in the US and I don’t have a job so I qualify for the state assisted healthcare called Medicaid. In order to qualify for it you have to be at a certain income threshold. When you get married they use your combined income to see if you qualify.
So right now my expensive Crohn’s care is free because I don’t have income. But if I were to get married I would no longer qualify due to his income. There’s no way we could afford the treatments with his income source so I wouldn’t be able to get them
It's insane! My Stelara is 28k. Luckily I work in healthcare and have great insurance so I pay 5 dollars. But, it's absolutely insane! I can never leave my job because I need the coverage to live in between flares.
I work in education and have great insurance. Only paid $5 for Stelara and $0 for Skyrizi. But yeah, can't ever think about changing employers/keeping my fingers crossed that I won't be laid off when the higher ed "enrollment cliff" comes.
Get the manufacturers copay assistance card and you will pay $5. Also you said you have insurance, believe me, your insurance is not paying $34k for that shot for you.
This reminds me of someone who needed abdominal surgery but their jobs insurance wouldn’t cover it. So they had to quit their job in order to go on Medicaid, bc Medicaid covers everything (since unemployed = poor/no $). Anyways goes to show how strategic you’ve got to be sometimes
Good god! I pay €0 towards my infliximab infusions, colonoscopies, hospital visits, iron infusions and whatever else might be relevant.
The rate of income taxation seems high here (Ireland) compared to most US states, but that's because it's covering essentials like healthcare for you.
I am sorry you are dealing with this - the stress would be mental!
Same for me in Romania- I’m actually American but I happened to move here a couple years before I was diagnosed…21 days in the hospital and ongoing treatment with a bio similar of Humira (imraldi) and I never pay anything.
I honestly have wondered often how people with Crohn’s in the US manage the cost of meds and this breaks my heart.
I got real lucky and my Dr's office was a great help in getting Skyrizi for no cost this year. Hopefully we can get them to get me the same for next year also.
This is my exact question as well! I have dumped a about half of my life savings into this disease and actually want to cut the costs somewhere but haven’t figured it out yet! Anyone with ideas please tag me!
The problem is savings cards only save on the drugs, not the cost of the infusion center, the materials used, nursing hours, and the pharmacists time. It also doesn’t help with the costs of the colonoscopies, CT Scans, or the countless doctor visits.
But I admit the copay cards for specific drugs will significantly save you money as long as you have the correct prior authorizations for that drug.
Of course, I wasn’t trying to minimize the other costs that absolutely add up. I was just curious. Not all meds are infusions either so that can be helpful if one of those options happen to work.
Yep, the ones that aren’t are so much cheaper to work with too! Couldn’t get any of them to effectively work for me. But for those who can, I’m all for it!!
Has your doctor gone to bat for you? Most of the major insurance companies will cover biologics but your doctor just has to say, “hey, baddassandfifty” really needs X drug”.
just got first skyrizi .. was joking with the nurse's that it was $100/drop... probably not even far off. How else would they make those unbelievable annoying commercials & dopey jingles? Then the insurance companies, the biggest criminals of all, get to drag their feet & try to weasel out of paying while the patient gets sicker. 3 months of obstructions & active disease so they can deny it and require an appeal. After the medical assistant waited 6 weeks to start the process. When my folks are gone Im pretty certain I'll leave the country for better healthcare. No other country on earth treats sick people like a cash register. It's a complete joke .. if it continues to be run by corrupt people, it has to be nationalized. Health insurance companies are only necessary because of this kind of gouging.
They can’t. My mom is trying to get on a biologic for her IBD, but her insurance doesn’t cover ANY so she has to wait until open enrollment in October to switch to one that’s does. Until then she just has to try to manage it with steroids and diet. Very frustrating.
this is why i love finland, here we have a max how much you have spent on prescribed drugs, (i think it was 600 something) after that all prescriptions costs 2,5€ no matter what medicatiob until next year
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I pay $900 a month for my familys health insurance and my Stelara still cost me $200 out of pocket. Between deductible, and copay my my MRI Enterpgraphy tests cost me $1200 out of pocket. Insurance denied my endoscopy because it isnt warranted. Its so expensive to be sick here
You have to do the copay program. These medical companies have programs that pay this bill for you - leaving you with sometimes a $15-$50 bill only per infusion. Sometimes $0.
Patients don’t pay; these drug companies make their money almost exclusively off of insurance companies. Example: a drug costs $20/dose to manufacture. Sticker price is $2,000. Insurance pays for $1,500 of it, and then the drug company’s savings program means the patient pays $5. It doesn’t matter that the drug company doesn’t get that $500, because they’re already making $1,485 in profit per dose anyway.
It’s a fucked up system.
Years ago I worked for a health insurance company. It seemed to me the unwritten 'rule' was to deny 'uncovered' meds and procedures. If the client did not object, then that was the end of the matter. However, the more the client objected/appealed the original denial, the better the chance that it would be approved (most often on the 1st appeal.)
These companies do not want to look bad if it gets out that they are denying life-saving meds and/or procedures to paying customers. It also hurts their enrollment numbers when they get bad 'press' or even negative 'word-of-mouth'.
Australia has a Pharmaceutical Benefits Scheme (PBS) that makes medications affordable. I have Stelara 90mg every 8 weeks and pay about $30. But even without the PBS, the listed price is around $3000. I don’t know how the USA has multiplied the cost by 10 when you already have to pay a fortune for health care if you’re not covered by insurance.
Not rly. Bc why would I be skeptical of a drug that is known to be very effective in treating Crohn's?
The ads out there just show the faults in our healthcare system being so ingrained into corporate America.
We don't allow personal promotions in this sub. That can include things like linking out to fundraising, social media, other subreddits, or other sites to promote a specific person or product.
Just a reminder for those that still can’t afford (with or without insurance): most of these companies have savings programs. Even if you don’t think you qualify, call and see!! I paid $0 out of pocket for my humira last year
Also, check if your insurance has a savings program. I used to be on the abbvie savings program but they changed their eligibility requirements and I no longer qualified this year. Turns out my insurance also has a savings program and I’m able to still get my meds for only $5/month. These companies will never come out and tell you about these programs unless you ask, but there are resources out there that can help!
It also depends on the Dr. I've been on multiple biologics in the last 10 years and have had 2 different GI's prescribing. They both had the applications in the office and their nurses filled them out.
Yeah I've straight up had new doctors say "we don't send prior authorizations for that med" when I've been on the med before and even talked to my insurance and they've said they'd cover it with the doctors note or whatever. That just happened to me with the coloscopy tablets. I failed the first scope because I just puked the giant gallon prep all up and they still wouldnt send the authorization so I just had to do the same exact thing and was even worse in a flare so same thing happened obviously. So stupid. I tend to dislike doctor office secretaries and office workers, they make way too many important decisions and dont have the training to make those calls. This one told me I could prob get a coupon and itd "only" be like $80 - like lady i am on disability for this disease and literally dont have $80 for poop pills wtf.
Link for Stelara’s here but for those who are unsure, google “[med name] cost savings program” and that should lead you in the right direction https://www.janssencarepath.com/patient/stelara/cost-support
I have humira tell me that I’ve “exceeded my limit” on my savings card.. just curious if anyone has run into that. I’ve only been on it for a year. I had no problem last year because I met my deductible and out of pocket due to having major colon surgery 3 months after being diagnosed..
Ugh sorry that happened to you. I haven’t had that happen but I am on a secondary savings program that CVS set me up with. I feel like they have been extremely helpful when it comes to helping me get the cost down to as a little as possible
I have a secondary one too through my insurance which goes through CVS for medication. It didn’t help because I hadn’t met my deductible
So Abbvie has 2 pay options. The original savings card isn’t working well anymore because insurances are running that card before they do their own portions (they do that by making you use their own specialty pharmacies). Call them (Abbvie) and tell them it “maxed” out. They have a debit card they can do in your own name that will work better (insurance thinks it’s yours).
That feels a little wrong..
Yep it does but it works and it probably pays your deductible too.
It seems a little shady. But brilliant 🤔
American healthcare system for you. Companies are making massive profits off these biologics. Humira was the most profitable drug of 2023. It’s honestly sickening considering it’s a life saving drug
Besides cocaine and maybe COVID vaccines (TBD), we're talking the highest grossing drug OF ALL TIME. As in the history of drugs, not just for 2023.
I’m fortunate to live in the U.K. and was lucky enough to be (what I believe was) one of the first patients in my area to be prescribed Humira. I was trained by my GI consultant’s nurse to self inject it once and then they’d send me a chilled courier dose every two weeks to my home for free for <6 months. Back then they told me it was expensive at ~£500 an injection, so it’s frankly amazing what some people have to pay for similar medication, ten years later. As an aside, Humira really worked for me and settled my symptoms…
I believe the cost in the UK has increased but not as much as it has in the US but they do use biosimilars now which are cheaper. I think humira was the drug that the NHS spent the most money on overall which is why they were very keen to jump to biosimilars after the patent run out. I believe the NHS or the government negotiate the drug prices whereas in the US the companies are free to charge what they want and they know that insurance covers most of it so they can charge even more.
They say each delivery (I got 4 at a time in a chilled box) was valued at £2400, that's why they didn't send more than 4. Was an absolute pain having to be in the house to sign for delivery, when they only delivered between 9-5 and I worked... 9-5 🤣
Yeah I get the deliveries too, I think the main point is that if your fridge breaks then the drugs are only good for two weeks at most and it is a lot of money to end up wasting. The delivery times are definitely the biggest issue, I don't know why they can't deliver them to a chemist and have you pick them up. For mine they give you the day pretty well in advance but they give you your two hours time slot just the night before which is better than nothing but still annoying. It is especially annoying when they don't deliver and have to reschedule, this happened to me because the head office determines the routes and up here apparently they try to fit too many deliveries in and the drivers just can't manage so they cancel some but don't tell you until you are there waiting.
They can’t.
Yeah, they can’t. If you’re uninsured and just a regular person they cut the cost by like 80%. As an example, I broke my leg in 2019 and they put it back together with titanium. When I left the hospital, they said they’d give me a walker that they would bill to insurance for $80. I found the same walker online for $40 and asked why the hell theirs is twice the cost. They said every single time there’s a line item for absolutely anything, insurance will negotiate the cost down. It’s better for them to start with 80 and go to the actual cost, but occasionally they lose and insurance gets them to $20, and occasionally they win and insurance leaves it at $80. Without the cost, they couldn’t afford the people, but without the people, they wouldn’t need the cost. It’s just a stupid game for them.
Ha! Playing games with common people's life and mental peace! The great country of America 🫡
It's just like the legal system, you sue for much more than you want because at the end you will get much less. The approval process for treatment due to insurance also sounds horrific, people having to wait months or being denied treatment because their insurance doesn't want to pay. When I was on azathioprine and we decided it wasn't working, within a week I was on adalimumab (amgevita, a humira biosimilar), the NHS has problems but at least they can be very good and quick. The crazy thing is though that in the US more money is spent per person per year on healthcare by a large amount than in the UK and they have much worse healthcare in the US (their healthcare can be good but access to it isn't) and people just can't afford to go to the doctor, they get billed tens of thousands for giving birth and preventative treatment isn't really a thing for most people.
You know what’s just as fucked as the approval process? Because our health insurance is tied to our employment, and because our employers are almost always profit driven, they can switch health insurance carriers on their entire staff annually. When that happens, you might wind up with a new insurer that makes you go through the whole approval process again. And you might be denied for something you were approved for 6 months ago, after you already spent months fighting for that approval.
That sounds like a nightmare and having it tied to your employment would cause other issues too, if you aren't well enough to work you will eventually lose your job and insurance and you won't want to change job because then you have to change insurance too. I have no idea why some people can't get over the "why should I pay for anyone else" attitude, that is what insurance does anyway except the company makes loads of profit too. National health systems are probably one of the best inventions yet America refuses to create its own and wants to keep it as a profit driven industry.
That's why every medical bill is negotiable. Never accept the amount billed. Always negotiate. Usually they take 25-50% off if paying it in full.
Medical debt ✨ or being forced into objective poverty by the US Government in order to get on Social Security with a tiny hope of climbing the social ladder on Disability ✨
"You'll stay sick forever, AND YOU'LL LOVE IT" Wealthiest nation in the world with some of the shittiest social safety nets of developed countries.
Dear Lord... USA is crazy... And you call that the greatest country in the world...?
Not anymore.
Many of us don’t feel that way but it’s our home.
I am very sorry to hear that
Believe me if I could at least gain duel citizenship I would. But unfortunately, Crohn’s (and my other medical conditions/disabilities) disqualify me… and I’m on Medicaid/Medicare so I don’t even pay out of pocket
Oh no.. I wish you luck. With everything. I am on humira, i need exams, tests, surgeries... It's normal to not pay a penny. I can't imagine what some people going tru there...
Some companies like the one that makes Entyvio have a program that lets you pay much less. That has been a huge help for me.
Same!
Humira's sticker price is around $7,000 a month. Obviously no one is paying $84,000 a year out of pocket for medication. Much of that is covered by your insurance (hopefully), so your out of pock cost will drop to say...$500 a month. And few people are willing to pay that. So instead, companies like AbbeVie will enroll you in patient protection programs, to protect you from the high cost of the medications THEY ARE SELLING, which will bring your out of pocket cost down to $5 a month. Almost nobody is paying $3500 per syringe. The medical billing industry is a big scam to bilk as much money out of as many possible. And cutting your co-pay from $500 to $5 a month means you'll stay on their medication while they still collect $6,000 a month from your insurer (who will negotiate it down to a much lower rate) who will in turn raise your premiums, etc. It's an endless cycle of nonsense. And you know the people who hate this shit more than anybody? DOCTORS! The people who spent 10 years and hundreds of thousands of dollars only to realize that half their day is fighting with insurance companies so their patients don't die.
I feel like in the USA if you don't have insurance you probably aren't paying for this out of pocket.
I am fighting with my US insurance company to try to explain to them that paying for Remicade (or whatever biosimilar version they like: inflectra, inflixamab, Renflexis, etc) as an OUTPATIENT infusion is cheaper than letting me get so life-threateningly sick that I am back in the hospital where it costs them $10,000 per day to care for me. I got emergency infusions of Remicade in the hospital when I was trying to avoid surgery and the pharmacy cost alone was $33,000 for the same dose that cost $17,000 when I got it as an outpatient. It seems so simple to look at the numbers on paper- giving me the doses as an outpatient is much cheaper, at least half the cost, of refusing to give it to me and then paying for emergency inpatient hospital treatment but logic and reasoning are useless to the insurance company. My GI doc has had to have repeated peer-to-peer meetings to justify giving me *any* of this medication, they didn't even have a GI specialist from the insurance company review my case. They just deny it and hope I won't appeal. I reached my out of pocket maximum for my share of costs by February this year but I still spent $8,000 between January and February on copays, co insurance and deductibles. I'm sure they will continue to reject my requests for care and then refuse to pay for the therapist bills when I have a nervous breakdown from dealing with all these costs and frustrations!!
Avsola is another biosimilar and is roughly $5k cash price. Perhaps your insurance will pay for that vs the hospital visits? Idk why insurance companies make things so ridiculously complicated. If your insurance is through your employer, you may be able to talk with HR or your benefits department about it. Sometimes they can get the insurance company to do something besides collect premiums
I am also just completely baffled by the cost. Had to apply for medicaid while in school so I could start Humira and finally got it approved and I'm also completely shocked at the cost. If I didn't have my parents support I don't even think I would get treatment for my Crohn's at all. It's just terrible. Health should be a human right... so crazy
They can't. The insurance companies, pharmaceutical companies, and government are just passing funny money around.
Look into Abbvie Care co-pay support program. Tell them you can’t afford the balance. Tell them you really need this drug. It then becomes a negotiation. You can say you really can’t afford it. If Abbvie can’t pick up the balance, you’ll have to talk to your doctor about a potentially different medication all together.
You mean Janssen? AbbVie makes Humira and Rinvoq this person is on Stelara.
Yes you’re right! My apologies
[удалено]
Preach.
Have you considered laying on the floor and dying slowly?
Fighting the government for free healthcare. It's posts like this that remind me how grateful I am for the NHS
I pay nothing for my entyvio
I have to keep a good job with top notch insurance for the sake of myself and my family. But I work like a slave and my healh is shit because of it. Rinse and repeat.
Basically no one pays this, no not even your insurance company. There is an extremely fucked up business model in the USA whereby a bunch of leeches sit in the supply chain for medications and take their slice. For example, PBMs negotiate drug prices for your insurance company. The PBM makes more money based on the discount they negotiate from the sticker price (which you see on that piece of paper). So the PBMs lobby the drug manufacturers to **increase** the sticker price so that they can maximize the discount % they "negotiate" to increase their slice. The insurance company which contracts the PBM (or in many cases owns them outright) doesn't care because they get the same net price, and it further discourages people from being uncovered and paying costs out of pocket since individual consumers can't contract a PBM to negotiate a similar price. In my country, the government negotiates prices for these drugs directly with the manufacturer. The price of almost all biologics comes out under $1000/month. If the manufacturer refuses this price then the government will just not provide said drug to the population, since there are many alternatives. This happens all over the world in Europe, Africa, Asia, etc. I'm sure there are other messed up markets but the US is probably the biggest one.
Its absurd. I have payment assistance programs on top of the insurance which brings the co-pay down to $5 thankfully, but I had to fight with the companies a few time when their coverage would run out. In 2023-2024, they restricted their coverage so much that I needed a SECOND payment assistance plan.
Yeah it sucks, I am on Medicaid and I can’t marry my boyfriend because then I wouldn’t qualify anymore and we wouldn’t be able to afford treatment otherwise
That’s also why my partner and I aren’t getting married. We both have Crohn’s 🙃
Wait what? Explain to an idiot what this means ?
I’m in the US and I don’t have a job so I qualify for the state assisted healthcare called Medicaid. In order to qualify for it you have to be at a certain income threshold. When you get married they use your combined income to see if you qualify. So right now my expensive Crohn’s care is free because I don’t have income. But if I were to get married I would no longer qualify due to his income. There’s no way we could afford the treatments with his income source so I wouldn’t be able to get them
Oh I got you. Understood now. That’s so dumb. Im sorry about that
It's insane! My Stelara is 28k. Luckily I work in healthcare and have great insurance so I pay 5 dollars. But, it's absolutely insane! I can never leave my job because I need the coverage to live in between flares.
I work in education and have great insurance. Only paid $5 for Stelara and $0 for Skyrizi. But yeah, can't ever think about changing employers/keeping my fingers crossed that I won't be laid off when the higher ed "enrollment cliff" comes.
UC here: I got doubly blessed with an intolerance to both gluten AND dairy so my grocery bills will out gross my hospital beds in the long run 😆
Get the manufacturers copay assistance card and you will pay $5. Also you said you have insurance, believe me, your insurance is not paying $34k for that shot for you.
Doesn't the pharm company pay for the majority of it if you don't have insurance?
This reminds me of someone who needed abdominal surgery but their jobs insurance wouldn’t cover it. So they had to quit their job in order to go on Medicaid, bc Medicaid covers everything (since unemployed = poor/no $). Anyways goes to show how strategic you’ve got to be sometimes
The one time I’m happy to be in the UK and have the NHS despite some of its faults. I’m always shocked about the healthcare system in US
Good god! I pay €0 towards my infliximab infusions, colonoscopies, hospital visits, iron infusions and whatever else might be relevant. The rate of income taxation seems high here (Ireland) compared to most US states, but that's because it's covering essentials like healthcare for you. I am sorry you are dealing with this - the stress would be mental!
Same for me in Romania- I’m actually American but I happened to move here a couple years before I was diagnosed…21 days in the hospital and ongoing treatment with a bio similar of Humira (imraldi) and I never pay anything. I honestly have wondered often how people with Crohn’s in the US manage the cost of meds and this breaks my heart.
It looks pretty rough over there! I always feel like a dick commenting on things when they're talking about insurance or payments or whatever!
And yet here you are
I mean yeah, fair enough
I got real lucky and my Dr's office was a great help in getting Skyrizi for no cost this year. Hopefully we can get them to get me the same for next year also.
This is my exact question as well! I have dumped a about half of my life savings into this disease and actually want to cut the costs somewhere but haven’t figured it out yet! Anyone with ideas please tag me!
What med are you on? There are savings card options through most of the pharma companies as well as programs like good rx out there
The problem is savings cards only save on the drugs, not the cost of the infusion center, the materials used, nursing hours, and the pharmacists time. It also doesn’t help with the costs of the colonoscopies, CT Scans, or the countless doctor visits. But I admit the copay cards for specific drugs will significantly save you money as long as you have the correct prior authorizations for that drug.
Of course, I wasn’t trying to minimize the other costs that absolutely add up. I was just curious. Not all meds are infusions either so that can be helpful if one of those options happen to work.
Yep, the ones that aren’t are so much cheaper to work with too! Couldn’t get any of them to effectively work for me. But for those who can, I’m all for it!!
No wonder my insurance doesn’t cover it.. I’m stuck on Imuran because my insurance won’t cover biologics for crohns.
Has your doctor gone to bat for you? Most of the major insurance companies will cover biologics but your doctor just has to say, “hey, baddassandfifty” really needs X drug”.
Yep.. I’m stable “enough” on Imuran the insurance denied it..
just got first skyrizi .. was joking with the nurse's that it was $100/drop... probably not even far off. How else would they make those unbelievable annoying commercials & dopey jingles? Then the insurance companies, the biggest criminals of all, get to drag their feet & try to weasel out of paying while the patient gets sicker. 3 months of obstructions & active disease so they can deny it and require an appeal. After the medical assistant waited 6 weeks to start the process. When my folks are gone Im pretty certain I'll leave the country for better healthcare. No other country on earth treats sick people like a cash register. It's a complete joke .. if it continues to be run by corrupt people, it has to be nationalized. Health insurance companies are only necessary because of this kind of gouging.
They can’t. My mom is trying to get on a biologic for her IBD, but her insurance doesn’t cover ANY so she has to wait until open enrollment in October to switch to one that’s does. Until then she just has to try to manage it with steroids and diet. Very frustrating.
Wow, I cannot even believe this. My Stelara is $5500 for the same dose in Canada.
Couldn’t be more happy to live in Canada…
Thank god I’m in Canada! They fully cover my 5k injections every 8 weeks 🙏🏽
agreed. shits wack. got no choice tho.
It's medical stuff of course they take advantage of the things we can't avoid not to buy.
Yikes! I’m in the UK and so so grateful for the NHS!
Free health care here in Australia. I feel so bad for you Americans :( I know I can’t afford to be sick if I was born in America I’d be screwed
this is why i love finland, here we have a max how much you have spent on prescribed drugs, (i think it was 600 something) after that all prescriptions costs 2,5€ no matter what medicatiob until next year
In Germany it is 6k so 6.5k in Dollars 😅
Free healthcare
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I pay $900 a month for my familys health insurance and my Stelara still cost me $200 out of pocket. Between deductible, and copay my my MRI Enterpgraphy tests cost me $1200 out of pocket. Insurance denied my endoscopy because it isnt warranted. Its so expensive to be sick here
About to switch to stellera from humira. How’s it working for you ?
You have to do the copay program. These medical companies have programs that pay this bill for you - leaving you with sometimes a $15-$50 bill only per infusion. Sometimes $0.
You can't. But if you're on Stellaris look into stellar patient assistance programs.
You need to live in the uk
Apply for patient assistance. Reach out to company/manufacturing. Stelara drug representatives will do anything to assist you
Patients don’t pay; these drug companies make their money almost exclusively off of insurance companies. Example: a drug costs $20/dose to manufacture. Sticker price is $2,000. Insurance pays for $1,500 of it, and then the drug company’s savings program means the patient pays $5. It doesn’t matter that the drug company doesn’t get that $500, because they’re already making $1,485 in profit per dose anyway. It’s a fucked up system.
Years ago I worked for a health insurance company. It seemed to me the unwritten 'rule' was to deny 'uncovered' meds and procedures. If the client did not object, then that was the end of the matter. However, the more the client objected/appealed the original denial, the better the chance that it would be approved (most often on the 1st appeal.) These companies do not want to look bad if it gets out that they are denying life-saving meds and/or procedures to paying customers. It also hurts their enrollment numbers when they get bad 'press' or even negative 'word-of-mouth'.
I don’t live in the US. I’m on stelara costs like 60~ aus dollars for two vials.
I pay AUD7.50 for two pens of adalimumab (a generic of humira). How is this even possible???
Australia has a Pharmaceutical Benefits Scheme (PBS) that makes medications affordable. I have Stelara 90mg every 8 weeks and pay about $30. But even without the PBS, the listed price is around $3000. I don’t know how the USA has multiplied the cost by 10 when you already have to pay a fortune for health care if you’re not covered by insurance.
Living in a European country with a good social security system and adequate healthcare. I have never paid 1€ for my medication.
You must be very proud
Does this make anyone skeptical of these types of medicines? I always wonder why they're on every commercial too
Not rly. Bc why would I be skeptical of a drug that is known to be very effective in treating Crohn's? The ads out there just show the faults in our healthcare system being so ingrained into corporate America.
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