Assistance for injectible medications

My rheumatologist has decided it’s time for me to begin an injectable medication to go along with the methotrexate I’m already on. She submitted a request to the entities that begin the “wheels turning” with this. So yesterday I got a call from her office saying it will be Cemzia and that I’d be required to pay 20% of the co-pay which is exorbitantly high for our budget. We’re retired and on a very limited income. We have a Medicare Advantage plan that we took because of my RA and all that it entails (office visits, medications and more.) SIGH!!! So the office person gave me an 800# for a medication assistance—so I called and that person said she couldn’t give an answer just yet due to the doctor’s office not giving her some information she needs. I was told upon getting that she’ll get back to me today or tomorrow. My question is, “what if I’m denied?” How can they expect patients to pay out of pocket that which they cannot afford??

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Comments

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  • Kelly Dabel moderator
    3 years ago

    Hi LibbyRa, thank you for reaching out. I’m sorry to hear that you are faced with this financial challenge as you prepare to start a new medication. You are not alone here! In addition to talking with your doctor about resources available to you locally and talking further with the Medication Assistance office you’ve already contacted, these articles may be helpful to you:
    Six Assistance Programs RA Patients Need To Know: https://rheumatoidarthritis.net/living/six-assistance-programs/ and
    Making Biologic Medications Accessible and Affordable: https://rheumatoidarthritis.net/living/biologic-accessible-affordable/. Please let us know any questions you have and keep us posted on what you find. Wishing you the best and that you will find the help you need. Kelly Dabel, RD – RheumatoidArthritis.net Team

  • LibbyRa author
    3 years ago

    An addendum to what I just posted…..let me say I was on “hold” for over an hour with SS. Add to that the time spent with the Cimzia person (twice) and then to let my clinic know as well. The ins. person with my clinic took all the info., she’ll tell the doctor and now I guess I’m waiting to see if the doctor will get back to me.

  • LibbyRa author
    3 years ago

    Thank you for the response AND for the list of assistance programs. I was on the phone this afternoon and came off rather frustrated and angry. I’d been in touch with the Cimzia assistance person…we don’t qualify! She told me to call SS and “perhaps” they’d offer something as well. Well I was told we don’t qualify with them neither. We’re not wealthy people..just average and the income is limited but we’re doing o.k. with groceries, a handfull of extras but quite honestly the $658.00 co-pay is way out of our reach as something else would have to be eliminated and I’m not sure what. I haven’t checked the list you posted as I’m just afraid it will be “the same song, different verse” with them. What do people do who have this awful disease and can’t manage to purchase the “said” prescriptions? I think it’s a scam to keep us all sick!!! Can you tell I’m frustrated??

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