Both Remicade & Entyvio are not in my prescription plan but are covered under major medical. Your doctor needs to get them pre approved for the med and the infusion center. Both have co-pay assistance through the pharmaceutical companies. The way it works for me is that the infusion center bills everything to insurance. Insurance pays what they allow and then you turn in the rest of the cost of the med only to the co pay assistance program. Usually after my first infusion of the year I hit my max out of pocket. But most of that max out of pocket is paid by co pay assistance.
Confusing and weird, but it's the only benefit of being on biologics. I have an infusion in January and have to pay my portion ($5) after co pay assist. Then the rest of the year all medical is free since I hit my max oop.
Oh that's awesome, so even though co-pay assistance is paying for it, as far as your insurance is aware you paid your max out of pocket so now everything else is covered? Nice
Thank you all for the replies. Great to know I may have these options.
Most drug companies also have a “free” option for those who don’t qualify under an insurance program. You have to do some nosing around to find it (it’s different/separate from the copay program). I get my migraine medication that way and used to get my Apriso the same
I’d call entyvio manufacturer and see what assistance they can offer. I’ve found the companies to be really nice and helpful. Applications are income based but they aren’t allowed to dig into your financiers for verification
Interesting, wasn't aware of the free option. So they can't verify and claim fraud or something?