Me, Myself, and Psoriasis / Today's Feature

My Medicine Cost $5000 for the First Month

My doctor decided the best medicine for my psoriasis at the moment will be Humira (A TNF (tumor necrosis factor)-blocker, whih works by blocking a protein (TNF-alpha) found in the body’s immune system that causes joint swelling and inflammation). This is a biological medicine that I would have to administer to myself through a shot a few times a month. According to Humira’s starter kit “In Clinical trails, must adults who use Humira for moderate to severe plaque psoriasis saw 75% skin clearance. And the majority of people were clear or almost clear in just 4 months.”
Humira-side-effects

I’ve been down this road before with Enbrel, another biological medicine that required me to give myself a shot in the thigh or mid section once every week. The website claims “In medical studies, nearly half of patients saw 75% skin clearance in 3 months. Overall, 3 out of 4 patients saw 50% skin clearance in 3 months.” Without insurance Enbrel cost around $2,000.00 per month. Fortunately for me I was able to take part of Enbrel’s patient program which only required me to pay $20 a month. (Click this link to find out more about their assistant programs http://www.enbrel.com/starting-ENBREL.jspx)

I was on the medicine for approximately 1 year, maybe a month or 2 less. The results? While I am extremely thankful for the opportunity of using the medicine, it did absolutely NOTHING for my psoriasis. Just my luck out of the 3 to 4 patients who “saw 50% skin clearance in 3 months…” I was the one who saw nothing. The good thing is I didn’t experience any of the 9 serious side effects which are a possibility, including liver failure and death.

Some people experience tremendous results when using these types of medicines. Look at Top Model Caridee English who was once covered in thick red patches, now clear thanks to the biological Stelara. I suggest you speak with your doctor to determine what will work best for you!

psoriasis-caridee_english

Top Model Caridee English

To make a long story short Humira is too costly for me to try, please review the following information to get a better understanding of the cost for me according to MY insurance (which will vary person to person):

The First Humira Shot I receive (which includes medicine and other items): $5,000.00 (Without Insurance)
Every shot there-after: $2,500.00

The Humira patient plan offered me $2,100.00 as assistance for the first month. My insurance will cover $2,700.00 for the first month as well, leaving me to pay approx. $600 for the first dosage.

In order for my insurance to pay for this prescription after the first month I am required to meet a $3,000.00 deductible, which means I must pay at least $3,000.00 out of pocket in medical needs. Once I reach this deductible they will cover up to %80 of my prescription cost, which then makes me responsible for %20 of the cost. Once I reach my deductible of $6,000.00 (remember, this is money I have to pay out of pocket first) my insurance will cover 100% of the cost…. But here is the kicker, the deductible process starts over again every year, so anything I paid in the previous year does not go towards the following year.

So in conclusion with “assistance” of the patient program and my insurance I will owe $1,500 per month for a medicine that I’m not even sure will work. **Long sigh**

I called my insurance company to get a better understanding of how a deductible works. Originally I believed that the money you pay every month went towards the deductible. When I found out the deductible is dependent on what I spend out of pocket I asked my insurance rep a bit of a rhetorical question, “So, you mean to tell me that I have to pay $3,000.oo in medical bills before you cover my medicine?” Her response? “Well you seem like a pretty healthy person, so I doubt you will have to pay that type of money.” I then asked her, “But if that’s the case how do I get the medicine I need for my psoriasis at an affordable price?” There was an awkward silence.

Although medicine for psoriasis can be costly check out my newest guest post on affordable treatment options.

Guest post: Obtaining affordable care for psoriasis

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4 thoughts on “My Medicine Cost $5000 for the First Month

  1. I have the same Insurence it sounds like. I was on Embrel about 5 years cleared 90% then after clear declined fron there on and a sinus and ear infections that have taken me almost 5 or more years to get rid of. And now they have perscribed Humera and with the cost I will stay just like I am dont want or nor can I afford the outragous cost nor the disappointment of the infections and the mental angush of breaking out over again. I will continue with homeaoathic stuff in search of the Holy Grail of a cure for Psoriasis and psoriatic ra.

  2. Alicia, Those prices are outrages and crazy. But, I am glad that things worked out for you with the price in the end. Unexpected blessing. However, continue to educate and I find it very brave of you to share your own experience. :-) Thanks for sharing!

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