Egosque and Remicade

[evanscyoc]

So, here's my situation. I have P and PA and I've had to switch companies three times this year and that means three different insurance companies. I didn't have any problems with Aetna or UHC, but currently I have Principal and they flat out refuse to pay for injectable meds except under major medical which leaves me with 20% of the cost. More than I can comfortably pay. So, I think we found a loophole and they will cover Remicade since its done in the doc's office. Any insight into how remicade works compared to Humira or Enbrel is appreciated.

Also, has anyone ever heard of egosque? Its a sort of physical therapy that works by aligning the body correctly. Kind of like ergonomics. It doesn't fix arthritis, but the lady said it would help with a lot of the other pain in my body. Guess we'll see.

[RichJ]

hi erik,
sorry i can't help much but i can bump you to the top. maybe some one will come through and help with your ?

have a good night all

richard

[PJ Leary]

Hi Erik,

Insurance issues can be a real challenge, believe me I know! Remicade, like the other biologics, works on the a-tnf cells to improve the skin & PsA. Each of the biologics is slightly different, and that is why one may work better for some patients than others. Some don't work at all for certain folks. Like all psoriasis treatments, it still comes down to a trial and error method of figuring out which medication is best for you.

That said, I have had excellent results with Remicade, and am still clear with my PsA well managed. I know many others who've had the same experience. Personally, I think it is very convenient to get an infusion once every 8 weeks. Then again, I used to spend more than 21 hours every week doing treatments just to try to stay as comfortable as possible.

You are correct that Remicade is classified differently than the other biologics by insurance companies since it is an infusion. I have BCBS, and even though it is more expensive than enbrel for instance, my co-pay is much less. I went from an out of pocket cost of $3000/year to $1200/year when I switched.

In my case, I did not switch due to cost, but due to loss of efficacy.

Let me know if you have further quesdtions.

Regards,

[evanscyoc]

Well, I just heard back from my insurance company and its the same deal as with humira or enbrel. I have to meet a $500 copay, then pay 20% until I reach $2500 for the year. With remicade I think I'd just reach that cap earlier in the year. Grrrr. Currently my doc is looking into a deal Enbrel has where they pay like up to $300 of copays a month for six months. Not a long term solution, but its something.

[Alyssa_B]

Erik-

You may have already seen this list posted elsewhere on the message boards, but I would recommend looking into the resources found at the following two links:

National Psoriasis Foundation Assistance Program list:

http://www.psoriasis.org/advocacy/assistance/insurance/programs.php


Additional prescription assistance programs (you do not need to be on Medicare to qualify):

http://www.medicarerights.org/rxframeset.html

Many of these programs offer assistance with insurance copays and deductibles, although certain income restrictions may apply.

Please feel free to contact me if I can be of further assistance.

Alyssa Brown
Advocacy Coordinator
National Psoriasis Foundation
abrown@psoriasis.org
Tel. 503.546.8407
Fax 503.245.0626

p.s. If you are interested in contacting the Patient Advocate Foundation Co-pay Relief Program, please do so on the first day of the month.

New calls are taken on a first-come, first-serve basis on the first business day of each month. The phone line is often very busy, so be persistent. Program staff suggest having friends and family call on your behalf in addition to making calls yourself to improve your chances of being accepted to the program. Leaving a message does not result in enrollment in the program; you must speak with a live person.

Due to limited funding, patients with psoriatic arthritis are typically only accepted on the first business day of the month. However, the Patient Advocate Foundation can assist you with any bills incurred in the previous year. Even if you cannot enroll at first, you maybe able to join the program the following month and obtain assistance with bills from the previous 12 months.

[MikeK]

You may have already seen this list posted elsewhere on the message boards, but I would recommend looking into the resources found at the following two links:

National Psoriasis Foundation Assistance Program list:

http://www.psoriasis.org/advocacy/assistance/insurance/programs.php


p.s. If you are interested in contacting the Patient Advocate Foundation Co-pay Relief Program, please do so on the first day of the month.

New calls are taken on a first-come, first-serve basis on the first business day of each month. The phone line is often very busy, so be persistent. Program staff suggest having friends and family call on your behalf in addition to making calls yourself to improve your chances of being accepted to the program. Leaving a message does not result in enrollment in the program; you must speak with a live person.

Due to limited funding, patients with psoriatic arthritis are typically only accepted on the first business day of the month. However, the Patient Advocate Foundation can assist you with any bills incurred in the previous year. Even if you cannot enroll at first, you maybe able to join the program the following month and obtain assistance with bills from the previous 12 months.A link to the Patient Advocate Foundation's Co-Pay Relief (CPR) Program can be found in the link that Alyssa gave us in her post ( thanks Alyssa :cool: ). That being said, here's the link again: http://www.copays.org/.

Mike

[Stillworking]

Remicade has a program called Remicare which may help with insurance issues and co-pays. Enbrel has the enliven foundation which does the same thing for prople on enbrel. I'm sure that Mike will be able to give you the links for these sites.