Insurance and Humira problem

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Kenny23
Regular Member


Date Joined Aug 2005
Total Posts : 128
   Posted 3/13/2008 7:44 PM (GMT -7)   
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 9:24 PM (GMT -7)   

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!

Ouch.

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 11:41 AM (GMT -7)   

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 :)


Kenny23
Regular Member


Date Joined Aug 2005
Total Posts : 128
   Posted 3/14/2008 2:52 PM (GMT -7)   
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.

praying4healing
Veteran Member


Date Joined Dec 2007
Total Posts : 739
   Posted 3/14/2008 3:38 PM (GMT -7)   
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!
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