Cimzia and Insurance

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Azstrait
Regular Member


Date Joined Dec 2005
Total Posts : 259
   Posted 10/14/2008 10:24 AM (GMT -6)   
I am to have my 3rd dosage this week. I have had nothing but problems with Aetna as far as misinformation, etc. I am enrolled in the Cimplicity program and have 3 free trial doses. Aetna tells me today that I need to pay 273.00 up front before  they will send out the drug tomorrow. I have a call into my Cimzia case manager and Aetna is supposed to call me back as well. My understanding is that the 3rd dose this week is free and then 6 mos. of co-pay assistance is supposed to be provided after that. The case manager told me last time that all of that info was given to Aetna. All Aetna does is transfer me around to different people each time I call. Has anyone else had any insurance problems when they started taking Cimzia, etc? How do you get an extension beyond the 6 months? Thanks for any info. I am getting really frustrated with all of this...
42 yrs, diagnosed Crohn's 1988, 2 bowel resections, 1 strictureplasty, 1 botched exploratory surgery, 1 emergency surgery for ruptured ulcer, Remicade every 8 wks, Immuran 100 mg, Protonix


ZenaWP
Veteran Member


Date Joined Aug 2007
Total Posts : 884
   Posted 10/14/2008 12:33 PM (GMT -6)   
Azstraight, I ended up not getting Cimzia (tried Humira instead, but will be switching to Cimzia now that I am in a flare on Humira) but the information that Cimzia told you is the same information they told me.  I get co-pay assistance with Humira and they actually show that I owe the amount on a statement until the drug company or whoever pays them, but I didn't have to pay anything up front.  What Aetna is telling you doesn't sound correct to me.  Ask to talk to a manager at Aetna.  That's what I did with Medco because I had issues when I first started getting Humira through the co-pay assistance, just with the reps not knowing what they were supposed to do.  I got mad and asked for a manager and she straightened everything out very quickly and told me that some of the reps gave me wrong info.  Hope you get it straightened it!   

Crohn's Disease, Acid Reflux/Gastritis, Hashimoto's Thyroiditis, Endometriosis, Arthritis, Depression/Anxiety.  Too many meds to list them all.  =) 


Azstrait
Regular Member


Date Joined Dec 2005
Total Posts : 259
   Posted 10/14/2008 2:58 PM (GMT -6)   
I did get it straightened out after several calls between Cimzia and Aetna. My Cimzia case manager called Aetna and apparently they are having a problem showing the correct info. from the Cimplicity program. The next 6 months are co-pay assist up to 500.00. I am wondering how much out of pocket I will have to pay on this? How much was Humira with the co-pay assist? Did you pay anything? I was on Remicade and was getting that a 100pct since all my out of pocket was met for the year...Anyway they are showing the 273.00 in error and will correct that and ship the drug out today.. Thanks for the info. Take care
42 yrs, diagnosed Crohn's 1988, 2 bowel resections, 1 strictureplasty, 1 botched exploratory surgery, 1 emergency surgery for ruptured ulcer, Remicade every 8 wks, Immuran 100 mg, Protonix


ZenaWP
Veteran Member


Date Joined Aug 2007
Total Posts : 884
   Posted 10/15/2008 12:19 PM (GMT -6)   
Azstraight, when I looked into Cimzia, my copay would be $200 for a 3 month supply, so hopefully you won't owe anything on top of the $500 they are paying.  Same thing with the Humira - my copay for 3 months is $200 and they pay for all of that for the first 6 months (they pay up to I think $1000/mo the first three months and up to like $600 the second 3 mos - don't remember exactly).  After that, I'm supposed to pay $50 per month and they will pay the rest (which only saves me $50 for 3 months but still, it's $50) for the next 6 months.  When I was on Remicade, they billed it through insurance to where I only had to hit my $1000 out of pocket max and they covered the rest.  They won't bill it that way for the Humira or Cimzia (said they aren't supposed to do that anymore), so both would come from Medco/Accredo to me.  

Crohn's Disease, Acid Reflux/Gastritis, Hashimoto's Thyroiditis, Endometriosis, Arthritis, Depression/Anxiety.  Too many meds to list them all.  =) 

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