Monday, April 7, 2014

A pitch for 3-month supply medications. The numbers don't lie!

Are you ready to hear some astounding prescription drug figures? 

I recently started CellCept again, after an almost seven-year hiatus. (After several years of plaquenil, prednisone, and a couple of pregnancies, it's time for another round of my favorite mycophenalate medication.) When I was last on the drug, from 2004-2007, I recall the medication being quite expensive, particularly because there was no generic available.  Thankfully, my insurance covered the brand-named drug completely, so we were relatively unaffected by the high cost, which at the time was approximately $800 for one month's supply of 2000mg/day. God bless health insurance.

Fast forward to today, and that's not exactly the case. While I have great insurance, it's one that has a prescription benefit cap. On this current plan, I have $1500 to spend on meds a year. For those familiar with prescription drug costs--that pays for a lot of prednisone, but not very much cellcept.

So when my doctor prescribed cellcept, I knew I was going to have to crunch some numbers to figure how this med was going to fit into our budget. First thing I did was to sign on for the generic form of the drug. Second thing was to call my insurance company. And here's what I discovered: 

At my current dosage (1000 mg), I pay a $10 co-pay, and the insurance company covers the cost of the generic medicine which is $322/month. 
After about 5 months, my drug benefit ($1500) will run out, maybe even faster since I'm still filling other prescriptions. 
Once that benefit is exhausted, the cost of the generic medication will be a $10 co-pay, plus $401/month, all of which I'll need to cover. Yikes. 
What's more, by that point, I'll be on 1500 mg, if not 2000 mg, so it will be even more than that. I opted not to price that out because of the good news I heard below: 

If I mail-order a 3-month supply of generic Cellcept at a time, the cost to me is a $20 co-pay, plus $84.  $84! And that's assuming an increased dosage of 1500 mg/day. Woohoo! 

What's more, I found out that my beloved local pharmacy participates in what my insurance company calls the Retail 90 Network program. As long as I obtain a 3-month prescription from my doctor, I can still go to my own pharmacy to have prescription filled, and see the friendly, smiling  faces of my pharmacists.  

I've always known ordering my medicine in bulk was cheaper, but I didn't realize how much cheaper. Believe me, I wish I didn't have to pay a cent over my co-pays. But discovering this massive savings has been a big "win" in the patient category. Bring on the Cellcept, and let it work its magic! 

5 comments:

Georgina Castellucci said...

I remember my first time filling my Cellcept prescription, a one month supply was about $300 while I had about 6 other prescriptions to fill. I was so thankful when that generic became available. Thank you for sharing, I am so glad I found your blog :)

xo Georgina (a fellow Lupi from Boston.)

Sara Gorman said...

I agree - three cheers for the generic! You're in Boston?? Hope you can come out on Sunday, April 27th for the Lupus Foundation of New England's Symposium in Cambridge. Hope to see you there! http://www.lupusne.org/LFNE_symposium_2014.pdf

A Yank said...

As a 30 year survivor, I remember well my first encounter with Cellcept and its $750/month pricetag.I knew then that I could never afford to be without prrescription drug coverage. While I too praise the existence of the generics, I would never praise the health insurance industry. They make plenty of money off of people like you and me, and they are NOT your friend. Obamacare may have leveled the playing field for us, but it is still very expensive to live with lupus.

Anonymous said...

Have you tried a whole foods diet-eating large amounts of greens and other veggies and fruits- getting off gluten and dairy, and taking supplements to combat lupus? I have read a lot about it and many have had much success and are able to get off their meds completely!

Drea Tyrell said...

It’s good that you found out about that particular detail. Now you only have to worry about your prescription every three months, and with that discount, it isn’t much of a bother anymore! Take care, and I hope the meds are working their magic as we speak!

Drea Tyrell | Anaheim Hills