Insurance and Humira problem

New Topic Post Reply Printable Version
[ << Previous Thread | Next Thread >> ]

Regular Member

Date Joined Aug 2005
Total Posts : 128
   Posted 3/13/2008 9:44 PM (GMT -6)   
Right now I have insurance through my college that takes care of the Humira, but I will be ineligable to renew my policy in July. At that time I will be switching over to Blue Cross/ Blue Shield PPO, BUT this plan will only cover 50 percent of brand name meds. So that means I would have to pay about $800 a month (half the cost of 2 Humira shots).

has anyone been in this situation and did you find help in any way? I know Abbott has a patient assistance plan, will this help me cover the cost? I definetly can't afford $800 a month.

kenny :)

Aimee =)
Veteran Member

Date Joined Jun 2004
Total Posts : 1020
   Posted 3/13/2008 11:24 PM (GMT -6)   

Wow - I have BCBS PPO but my prescription coverage is through Medco and I pay a tiered copay on medication. I have never heard of the brand name restrictions!


Who is selling Humira for $1600? My local pharmacy told me it's $3200 a box but mail order pharmacys through the insurance is probably much cheaper.

Yes - my understanding is that the Abbott will help significantly in the cost. I would call ASAP and visit with someone about getting coverage. I did not bother to call since I only pay $40 a box for mine, which we were able to budget, but know many on here have gotten great help from them.

map lady
Regular Member

Date Joined Feb 2008
Total Posts : 154
   Posted 3/14/2008 1:41 PM (GMT -6)   

Are you sure there is no cap on drug co-pays?  I have blue cross HMO also, and my policy also says only 50% coverage of "non-formulary" (brand name) drugs but they have a cap of $75 per prescription.  If you need a drug that is $80 they'll make you pay $40 since that's half.  If you need a drug that's $150 you'll pay $75 since that's half.  If you have a drug that's $400 you still only pay $75 since that's the per-prescription cap that you can be asked to pay.  I know that would still suck since that's $150 a month for your 2 shots, but it's much less of a scary number than $800.

Hope abbott helps you out, but if you need any other relatively pricey medicines there should be a cap of how much you can be asked to pay per bottle of pills.  Hope that helps relieve some of the stresses of going to the pharmacy :)

Regular Member

Date Joined Aug 2005
Total Posts : 128
   Posted 3/14/2008 4:52 PM (GMT -6)   
I appreciate all the suggestions. I will be calling Abbott soon. I'm really hoping they offer some assistance.

THE bc/blue shield insurance I am getting is personal choice PPO. I live in PA if that matters. It's pretty much the only individual plan I qualified for (open enrollment). I will re-read the policy to see if there are caps but I sort of doubt it.

Veteran Member

Date Joined Dec 2007
Total Posts : 739
   Posted 3/14/2008 5:38 PM (GMT -6)   
I have the abbott card, but i have horizon ppo and i only have a 25 dollar co pay, so i'm surprised that they wont pay for yours in PA, i work for them, but in dental, but ny,pa,and nj plans are usually the same. When u find out what the deal is let us know please!
25 y/o female- crohns disease since 14
Ileostomy pending-very worried
Tried asacol,pentasa,prednisone,remicade,6mp,azasan, no avail
Seatons placed
Worst year ever!

"For God has not given us the spirit of fear....."
Where does mine come from?!
 Temp Ileostomy performed 1/29/08
Still Adusting has been my Godsend...Thank you

New Topic Post Reply Printable Version
Forum Information
Currently it is Wednesday, October 26, 2016 6:05 PM (GMT -6)
There are a total of 2,712,576 posts in 299,107 threads.
View Active Threads

Who's Online
This forum has 153689 registered members. Please welcome our newest member, Coffyy.
383 Guest(s), 12 Registered Member(s) are currently online.  Details
Mews2much, Coffyy, island time, Serenity Now, astroman, Tick41, InTheShop, Old Mike, vaportrail, ozmadman, ozmadman, minnietoty

Follow on Facebook  Follow on Twitter  Follow on Pinterest

©1996-2016 LLC  All rights reserved.

Advertise | Privacy Policy & Disclaimer