The Price Tag on Potential Comfort

At my last rheumatologist appointment, my doctor asked me how the transition from Orencia subcutaneous injections to intravenous infusions was going. It’s too soon to compare the benefits of these two drug administration methods on my RA symptoms, as it may take a few more months to receive the full benefit of the IV medication. However, my doctor sees me as a whole person, and takes into account the ways medical treatment can impact a patient’s life beyond disease control. He asked if I was finding the infusion visits inconvenient or if I was having a problem with the IVs. I told him his office’s infusion center is very efficient and friendly, and that I’m okay with getting IVs, but that the cost difference is significant.

When I was taking Orencia injections, the manufacturer offered a copay assistance program, so I was only paying five dollars a month. This program does not extend to the intravenous version of the medication, so the out-of-pocket portion I’m responsible for is $120 per month. That comes out to an annual difference of $1,380!

At my prior appointment, my rheumatologist and I decided to switch to the IV form of the medication because we both agreed that my rheumatoid arthritis disease activity level was too high, and I didn’t want to increase the dosage of my other medications. I’d been frequently ill throughout the months prior, and didn’t feel like my immune system could handle much more suppression. My doctor said having the drug go directly into my blood stream could improve its efficacy, and I did well on Orencia infusions when I was last on them in 2008, before I went off of all my meds in order to get pregnant. While the infusions seemed worth a try, he was not able to predict how much my out-of-pocket cost would be, as insurance rates vary so much from plan to plan. When his office called me a few days after my visit to let me know how much each infusion would cost, I balked at the price. Yet, it’s hard to place a value on good health.

If I could go to a store and find “RA remission” on the shelf, I’d happily pay $1,380 for it. However, when we try out new medications, we aren’t guaranteed any results. I may spend this money and find that the infusions make a world of difference, and are well worth the financial cost. I may also discover that I don’t see any improvement on the IV drugs versus the injections. It’s a crapshoot, and an expensive one at that.

Having rheumatoid arthritis involves so much uncertainty. It’s impossible to predict how I’ll feel on a given day, how I’ll respond to an activity, or how I’ll respond to a medication. My sister also has RA, and she found that Xeljanz works wonders for her symptoms. Yet, when I tried the same medication I didn’t notice any improvement. Even people with the same disease and the same genetic makeup respond to RA drugs differently. Therefore, I have no way of knowing whether it will be worth it to shell out the extra money for Orencia infusions or if I’d come out ahead sticking with the injections.

My doctor and I ended up deciding to give the intravenous Orencia a six-month trial run. At that point we’ll evaluate how I’m doing, and I can determine whether I want to stay on this pricey form of the medication. I like having a plan, and that’s a plan I’m as comfortable with as I can be with my current options. Yet, I know that next week when I go in for my infusion and I have to ante up the $120 required before treatment, I’ll wonder if the odds of this bet are in my favor.

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