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Biologic- How to get it covered

Fri, October 08, 2021 8:08 PM

Hello. My daughter 10 years old after almost 18 months of symptoms has been diagnosed with Crohn's disease. Her GI wants to put her on Stelara and if not Stelara feels it is very important that she is put on a biologic. She has fallen from the 50th percentile in weight and height to the 5th. I find myself in the worst possible situation where my health insurance has a no specialty drug rider on the policy, they will not cover any biologic under any circumstances. We do not qualify for Janseen's Carepath assistance for copays because we have insurance but it covers nothing. We do not qualify for the other programs because they say our income is too high. The cost of Stelara, Humira or Remicade is more than my entire Salary after taxes and I will lose my house if I pay that much for medication. Has anyone been in this situation? How did you get the drug covered? Can you get the manufacturer to help? I don't know where to turn next. 

FPO orthopt2003
Joined Oct 8, 2021

Fri, April 19, 2024 7:55 AM

Reply posted for orthopt2003.

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FPO brianbertrand
Joined Apr 19, 2024

Tue, October 24, 2023 11:39 PM

Reply posted for janetteanso.

I’m sorry to hear about your daughter’s diagnosis and the challenges you are facing with insurance coverage. It’s understandable that you are looking for ways to get the medication covered. Here is a options that you can consider:
Patient Assistance Programs: Many pharmaceutical companies offer patient assistance programs (PAPs) that provide free or low-cost medications to people who cannot afford them 1. You can check if the manufacturer of Stelara, Humira, or Remicade offers a PAP that can help you cover the cost of the medication.
I hope these options help you find a way to get the medication covered. Please note that some of these options may take time and effort to pursue, but they may be worth exploring given your situation. Let me know in geometry dash subzero if there’s anything else I can help you with.

FPO janetteanso
Joined Oct 24, 2023

Thu, June 15, 2023 2:03 PM

Reply posted for orthopt2003.

If your insurance won’t cover the medication go to the maker of the biologic website they have a lot of cost effective options as low as five dollars but it’s different with each company 

FPO gameofcrohns42
Joined May 11, 2023

Fri, June 02, 2023 11:47 AM

Reply posted for orthopt2003.

Abbvie has a discount program initiated by your prescriber. But with me that was the easy part.
I made an appointment with my GI in January, didn't get the appointment until May 2 the Humira was approved quickly however, No one to blame but here at June 2 sttill no drug!!
wrong specialty Pharmacy,,, no dosage instructions , verbal requests required, wrong address on file, maintence dose approved before the loading dose,,,,,, it will go on and on! The insurance companies acted fine the Pharmacy benifits manager was fine both Kroger and Accredo were super fine. So it all goes back to the incompetence created by under paid, overworked and unexperienced provider staff!!!. My GI sees 60 patients a day at $346 per visit on average, then sits down with a donut and makes 3 girls do all the work. Be prepared!!!!!

FPO Bobby
Joined Apr 29, 2023

Sun, January 22, 2023 6:15 PM

Reply posted for orthopt2003.

Have you been able to find any help? Is the issue that your insurance does not cover the biologics like Humira and Stelara at all? I have contacted the manufacturers of some medicines through their websites and received some help with a copay card or other assistance. I agree the treatments are very expensive. Has your doctor been able to help with connecting you with resources who may help? I recently joined the forum and just saw your post, and I hope you have been able to find some answers. Affording this disease is always on my mind and it is the last thing you need to worry about when your family desperately needs a medicine.

FPO Max1970
Joined Jan 22, 2023

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