7 replies to this topic

[xGunner]

The joys of HSA.

 

The first 7 years of Gleevec brought the January gift of maxing out the yearly deductible from the HSA. Then, in 2016, the Novartis co-pay card paid for that big hit. It gave my HSA a reprieve for a year to try get it's feet back under it.

 

Now, my insurance company (Thanks United Healthcare!) will not do business with Novartis, and requires me to use a generic. Their current choice is Apotex. Apotex has a copay card as well. They will contribute $700 towards the cost! (I guess that is better than what Novartis helped out the first seven years...).  Except that they won't work with my prescription. I take 4x100 mg (2 in the morning, 2 in the evening). They refuse to pay anything because the view 120 pills as a 4 month supply, and will not contribute to anything more than a 3 month supply. I am out of pills in two days. We have been going around and around with Briova (aka UnitedHealthcare Specialty Pharmacy) for about 10 days.

 

I will probably end up paying for it all out of my pocket. And then, I will drop my dosage back to 3 a day for a couple days each week so I can skip two prescriptions towards the end of the year. That should take about $10,000 out of their pocket.

 

Oh well, just another day!

 

One thing about the HSA account- I had a decent balance before the diagnosis, and with the red-hot stock market I have been able to hang in there. I put the max into the account each year, the drug companies take the max out each year, and the balance just sort of hovers.

[jmoorhou]

You can cut up the 400 mg Gleevec...that is what I do to take 300 mg....

[r06ue1]

Can you get the 400 mg and split the pill?  

 

Many states have laws which allow you to choose the brand name drug even if the insurance company labels it as not covered.  I am currently with Anthem/Blue Cross and I requested the brand name for this year and my doctor wrote on the prescription DAW (dispense as written) which requires them to give me the brand name.  The insurance company charges you (Novartis really) for the cost difference between the brand and the generic but they never gave me any trouble and it took one day to get approved.  

 

Might check the DAW laws for your state.

[xGunner]

The cost for 4x100mg is exactly the same as 1x400mg. If I had known that the Apotex rules were going to be a problem, I could have had the prescription changed to 400mg. It does not make sense that they will not honor the $700 copay on 120 pills, but it is their policy.

 

The insurance company (UnitedHealthcares specialty prescription service) has a strict no insurance for Novartis Gleevec product. I can buy it, pay full price for it, and it will not count against the max out of pocket. The Apotex Generic is only a few thousand less than Gleevec, but it is the only option for me at this time. (The only option where I will get any insurance coverage.)

 

I have no loyalty to Novartis. Through my high deductible plus insurance, we paid full price for 7 years. They picked up the deductible last year. I have been taking the generic now for two months, no problems. It just looks like I will be paying the max out of pocket this year as well.

 

Apotex is advertising what a good deal their co-pay card is-

 

<<If eligible, most commercially insured patients will have $0 out-of-pocket cost with the Imatinib Instant Savings* Program toward each 30-day supply, and the program will pay up to $700 per 30-day supply towards your cost-sharing obligation.>>

 

Makes for good advertising, but a high deductible plan holder will pay all but $700 of the $first months bill. In my case, around $4900. I may go the route of getting the prescription changed to 400mg 1 per day. That should save me the $700. I would only miss about a week of pills. And that is assuming that the Apotex copay card would work.

[shweflen]

jmoorhou,  how do you cut the 400 mg to get 300 mg?  I have split the 400 mg to get 200 mg but am afraid that I will make a mess of trying to split a half with no score mark.

[Antilogical]

When I transitioned from 400mg to 300mg, my onc told me to split some 400mg tablets in half, & alternate between 200 & 400.

[jmoorhou]

Check with the Leukemia Society LLS sometimes they can help.

[xGunner]

It has been resolved. It took 16 phone calls from us, with 3 phone calls from Briova. Apotex could not deal with the concept of taking more than one pill per day.

 

We ended up getting the prescription changed back to 1 pill per day, 400 mg. The twice a day dosage helped with stomach issues. I will try splitting pills. And after I max out the deductible, then maybe switch back to 4 per day of the 100 mg.

 

I let myself get stupid in the accumulation of pills. At one time I had a stash of about a month's worth. Pills that I did not take because I did not feel good, or just simply forgot. I let me wife deal with the hassle of the specialty pharmacy, and she just used them up. So I had no spares when it came to the first of the year.

 

We won't make that mistake again. I will miss about a week of pills here. I hope that the refill gets here today, but it could be tomorrow...

 

On the good news side, they let me fill a 90 day supply. For the past 8 years, it has been a limit of 30 days at a time. This fit into Apotex's format, so they picked up $2100 of the copay. So my share of the copay will be $3900 this year.