13 replies to this topic

[xGunner]

Just ordered a refill through the online pharmacy that my insurance plan requires me to use.  I am on a high deductible plan, so the first $5700 or something like that is out of my pocket. (it actually is a bit of a formula, I pay the first 100% up to $4800 then 25% until my total out of pocket is the $5700 or whatever number.

 

Anyways, I had signed up for the Gleevec co-pay card in December. Had in on file with the pharmacy. Ordered the refil, the co-pay card covered $5200 worth, I paid $10, my insurance covered the balance.

 

So, if you are on an insurance plan, the co-pay card works! It beats the $5400 that I had to pay out of pocket last year.

[Terran]

Yea! I celebrate with you. That's great.

[Mschmidli]

I just got approved for the copay card today. My insurance company said they have to verify the info before I can use it. They told me to call back tomorrow. Hopefully it goes thru- they said my copay would have been $7300 which can't be right because my out of pocket for the year is only $4400. Gotta love when the new year hits and no one knows what's going on

[r06ue1]

I believe I had the same insurance last year, it was great insurance for the family, $6400 max out of pocket and the company contributes $800 so effectively making it a $5600 out of pocket.  

 

Then I was diagnosed with CML; my medical insurance didn't cover biotech drugs so I was hit with nearly a $1900 bill the first month which maxed me out and then another $650 bill when my daughter was born (max went up for the year).  I changed my insurance this year to a plan that also has medication coverage so my out of pocket max is now $1,000 and the monthly bill for my "biotech" is now $135.  

 

I was reading the small print on that orange card (received mine with my December shipment) and it states that there is a $30,000 max for the year.  From my understanding, once you hit that max (three months in all likelihood), you will be responsible once again for the max out of pocket and get hit with the big bill in four months.  That money appears to all go to the insurance company and not to the individual (which would pay our out of pocket for the year) unless I am mistaken.  Anyone used this card in the past and can verify this?

[Buzzm1]

I believe I had the same insurance last year, it was great insurance for the family, $6400 max out of pocket and the company contributes $800 so effectively making it a $5600 out of pocket.  

 

Then I was diagnosed with CML; my medical insurance didn't cover biotech drugs so I was hit with nearly a $1900 bill the first month which maxed me out and then another $650 bill when my daughter was born (max went up for the year).  I changed my insurance this year to a plan that also has medication coverage so my out of pocket max is now $1,000 and the monthly bill for my "biotech" is now $135.  

 

I was reading the small print on that orange card (received mine with my December shipment) and it states that there is a $30,000 max for the year.  From my understanding, once you hit that max (three months in all likelihood), you will be responsible once again for the max out of pocket and get hit with the big bill in four months.  That money appears to all go to the insurance company and not to the individual (which would pay our out of pocket for the year) unless I am mistaken.  Anyone used this card in the past and can verify this?

GLEEVEC Co-Pay Assistance Program http://www.oncologya...377031731608905

*Limitations apply. Patient pays first $10 co-pay on a 30-day supply, and the program will pay up to $9690 per 30-day supply up to an annual max of $30,000. This offer is not valid for cash-paying patients, Medicare, Medicaid, or any federal or state program. Please visit www.GLEEVEC.com, or call 1-866-GLEEVEC for the most up-to-date terms and conditions.

[dlb65]

Gunner:

Just curious. Does your insurance apply the $5200 the co-pay card paid towards your deductible? If not, we are just delaying the inevitable for 90 days. My understanding was that it did apply to your deductible, thus when the generic comes out, there would be no reason to switch as you have maxed out both your deductible and your Out of Pocket max. That is the strategy, as I understand it, behind Novartis' generosity.

[xGunner]

Gunner:

Just curious. Does your insurance apply the $5200 the co-pay card paid towards your deductible? If not, we are just delaying the inevitable for 90 days. My understanding was that it did apply to your deductible, thus when the generic comes out, there would be no reason to switch as you have maxed out both your deductible and your Out of Pocket max. That is the strategy, as I understand it, behind Novartis' generosity.

As near as I can tell, it applies to my deductible and possibly max out of pocket. I will know more in mid February.

 

The so-called generosity is aligned perfectly with keeping patients on Novartis Gleevec. I have sent them probably $40,000 as my part of the deductible and copays over the past 8 years. I just checked my plan, max out of pocket now is $5800. After my next refill the 1st of February, I will learn if the card has satisfied my max out of pocket, or not. Potentially, the card will drop my out of pocket to $20 for the year, with the card picking up $5780 (assuming I have no other medical charges before Feb 15th). This would allow my HSA to actually start building up again.

[r06ue1]

That would be great if it does work that way, no copay and deductible to worry about other than the $10 a month.  Is the card new for this year or has it been used in the past also?  

[Gail's]

I was sad to see you can't use it if on Medicare. I'm doing ok with the cost now due to really good insurance but will lose that coverage when I retire and will have to go on Medicare.

[xGunner]

OK, so it is mid February and time for an update.

 

The co-pay card did indeed satisfy my max out of pocket expenses. After the second month delivery, the amount that the co-pay card paid plus my $20 equaled the max out of pocket for my HSA costs. I had some miscellaneous prescription to refill a couple days ago, and it showed up with a $0 copay.

 

After 8 years of paying the max out of pocket every year, it looks like we will be able to begin building up the HSA again.

[chriskuo]

Remember that the donut hole on Medicare Part D is being reduced to 0 between now and 2020 and the cost in catastrophic phase is capped at 5% copay.

[r06ue1]

Good news xGunner, congrats!

[Calvink669]

Sprycel has a similar co-pay card that works the same way.  I have a 2600 family deductible that it paid for in January.  Pretty good deal if you ask me.

 

https://www.sprycel.com/one-card#

 

Calvink

[r06ue1]

Good info Calvink, thanks for posting that.