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sarahsweets
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Default Sep 24, 2021 at 05:37 PM
  #1
I am pretty savy when it comes to finding coupons, rebates etc. I save so much money at the grocery store with my digital coupons they have to have the manager do an override usually. We all know that prescription pricing is literally the wild west and I have yet to have anyone explain the pricing of drugs, or those handy dandy patent rules or how patient assis / savings cards from manufacturer programs work. I have been down the prior auth road many times and most of the time it works out. I am relentless and have even made appts with my husband's HR and taken up their lack of coverage directly with them.

Today's insurance issue: I need this- ahem- 'ring' for inside me to help with menopause symptoms. It was sent to my local pharm. Its a 90 day thing- in on day 1 out on day 90. First I was told that if I want a 90 day supply I have to use mail order (its one ring not 90 pills!). Then the dr sent it to my rx company. I called them and after being on hold and disconnected for over an hour I was told that in fact they didnt cover it at all. So I googled and found out the company has a rx savings rebate. I could pay as low as 25$ per ring. I called my local pharmacy back and they said that the card is only good for people with insurance that DOES cover it but that has a high copay. Well if my insurance doesnt cover it why cant I get help with programs like these? I thought the manufacturers sort of had a fund for stuff like this, and the promotional value of more people using it- I thought would be a company incentive. One ring is between 500-690 according to goodrx. My highest copay is 40$ so I could really use the help. And if you have medicare or medicaid and need help? Forget it with the manufacturer coupons. you must have commercial insurance to qualify. My mother is on medicare and her inhaler isnt covered. She has to use an inferior one and even that is 300/month.

So how does all of this work? Does anyone understand the savings programs, cards, patient assistance etc?

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Default Sep 24, 2021 at 05:41 PM
  #2
Just want to let you know I sympathize but as for dealing with all this I’m at lost too.

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Default Sep 24, 2021 at 08:51 PM
  #3
There are patient assistance programs that provide meds for no cost. They usually have an income limit and say if you have insurance you don't qualify. However they will make exceptions and I've found they are quite generous with the exceptions. I'm on medicare and it just doesn't cover several of my meds and those meds are hundreds or over $1000 and I just apply, include a note explaining that I technically don't qualify but am asking for an exemption because there is no way I can afford the med on my income (I usually try to tell them what the cost would be). And I've always been approved.

I don't know that they will definitely make an exemption when you have commercial insurance but it's worth a try. And your mother's inhaler should be covered that way; mine is and has been for many years.

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Default Sep 25, 2021 at 07:20 AM
  #4
There are certain medications that are just expensive, unfortunately (based on nothing, really). I had Latuda prescribed for me and there was literally no option to get it cheaply.


If I understand correctly, in this case, IF your insurance will cover it YET the copay is UP TO $400, THEN the manufacturer will give you a coupon to pay as little as $25.

I did some research on this. I believe the key is getting your insurance to cover it (even if it is still a high copay). Then, after that, you can use the manufacturer coupon card. I hope this helps somewhat.

Getting your insurance to cover it (this might be having your doctor call them, appealing it if they deny it, etc.) might be the hardest part.

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Default Sep 25, 2021 at 09:14 AM
  #5
So what you’re talking about I used with Abilify....my copay was super high and got reduced to 25 bucks.....pharma uses these programs because they can get hundreds to thousands from your insurance and then hand you some savings so they don’t really have a pool of money for these they’re refusing insurance cost directly to you.

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sarahsweets
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Default Sep 26, 2021 at 12:43 AM
  #6
Hey @WastingAsparagus are you still dealing with the latuda issues? I will share this only because I just helped my daughter with it:

Copay Savings and Support | Latuda(R) (lurasidone HCl)
Quote:
LATUDA $15 Copay Savings Card
Eligibility
To use the card, a patient must be 18 years old or older, with a valid prescription for LATUDA

For a patient between the ages of 10 and 17 with a valid prescription for LATUDA, an adult (Legal Guardian) must use the card on the patient's behalf

LATUDA Copay Savings Program Terms and Conditions
By using this card, you acknowledge that you currently meet the following eligibility requirements:

You must be 18 years of age or older to accept this offer. This offer is valid only for eligible patients and legal guardians of eligible patients. Patients must have a valid prescription for LATUDA within LATUDA's approved indications

Offer not valid if prescription is paid in part or full by any state or federally funded health care program, including but not limited to Medicare, Medicaid, VA, DOD, or TRICARE, or where prohibited by law

This card is valid for up to $400 off a 30-day supply or up to $1200 off a 90-day supply. The card is further limited to twelve 30-day supply uses or four 90-day supply uses in a calendar year with a valid prescription

Offer is limited to one per person and may not be used with any other offer

This program is not health insurance. The amount of the benefit cannot exceed the patient's out-of-pocket expenses. Acceptance of this offer must be consistent with the terms of any drug benefit provided by a health insurer, health plan, or other third-party payer. If requested or required by any such payer, the patient must report the use of this card. The patient must deduct the value of the savings received under this program from any reimbursement request submitted to the patient's insurance plan, either directly or on the patient's behalf

For California and Massachusetts residents, benefits pursuant to this card will terminate automatically upon the introduction of a therapeutically equivalent product

Offer valid only in the United States and Puerto Rico. Void where prohibited by law, taxed, or restricted

Sunovion reserves the right to rescind, revoke, or amend this offer at any time without notice. This offer is not transferable and may not be sold, purchased or traded, or offered for sale, purchase or trade

*Must meet eligibility requirements. For commercially insured patients, this Copay Savings Card covers out-of-pocket expenses with a maximum benefit of $400 for a 30-day supply or $1200 for a 90-day supply. The card allows up to twelve 30-day supply uses or four 90-day supply uses in a calendar year with a valid prescription. Please see full terms and conditions.

Message & Data Rates may apply. Message frequency varies. Terms & Conditions apply: Latuda Savings Program | Text Alerts. Once enrolled, text HELP for help. Text STOP to end.

Quote:
Originally Posted by WastingAsparagus View Post
There are certain medications that are just expensive, unfortunately (based on nothing, really). I had Latuda prescribed for me and there was literally no option to get it cheaply.


If I understand correctly, in this case, IF your insurance will cover it YET the copay is UP TO $400, THEN the manufacturer will give you a coupon to pay as little as $25.

I did some research on this. I believe the key is getting your insurance to cover it (even if it is still a high copay). Then, after that, you can use the manufacturer coupon card. I hope this helps somewhat.

Getting your insurance to cover it (this might be having your doctor call them, appealing it if they deny it, etc.) might be the hardest part.

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WastingAsparagus
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Default Sep 26, 2021 at 03:49 PM
  #7
Quote:
Originally Posted by sarahsweets View Post
Hey @WastingAsparagus are you still dealing with the latuda issues? I will share this only because I just helped my daughter with it:

Copay Savings and Support | Latuda(R) (lurasidone HCl)



I appreciate it, @sarahsweets - this was a long time ago (like 5 months ago), and I had already decided not to take the Latuda at that point. My current meds seem to do the trick. Anyway, thanks.

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