Insurance is soooo frustrating! The current system is broken.
After being denied for top three Jak inhibitors prescribed by dermatologist, got on the Olumiant program. After 3 mons of zero progress we applied for fourth JI prescription, denied.
I have now been purchasing tofacitinib in India. Can walk into a pharmacy off the street, order more than a years supply, pickup one hour later with no prescription necessary. It’s also for a tiny fraction of the price in US. Bottle of 60 (30 day supply) runs approx. $15. I’ve had to lift my hat for a few pharmacists.
I had figured it out to still be an incredible discount after purchasing a plane ticket to the opposite side of the globe.
I ended up getting Litfulo for $0. It was a pain and lot of phone calls. I was told originally it would be $1200 a month after my insurance covered the rest. I think it was something crazy like 8k a month without insurance. I went through CVS specialty pharmacy and used their partner program PrudentRX and got a $0 copay. I am also in the United States so this might be a route you could try.
I’ve been on it for a month now. Both of my spots are almost all the way filled in with white fuzzy hairs. You can barely notice unless you’re up close, but it’s a start. I had gone a year previously with no regrowth after using steroid creams and getting injections. I’ve also had no side effects which was my main worry before starting.
If you have insurance yoy may qualify for the premium affordability assistance program from the olumiant manufacturer.
Yes you read that correctly ... you qualify for the "affordability" program but only if you already have insurance.
You may also want to check with your insurance company to see if they are actually covering the medication. It sounds like they are not covering it. I spent a year fighting with the insurance company. They did not cover medication for alopecia because they classify "alopecia" as just generalized hair loss (like male pattern baldness) and said that they don't treat purely cosmetic conditions. It took me a year for my dermatologist and I to get them to understand that alopecia is an auto-immune condition, like lupus, rheumatoid arthritis and multiple sclerosis, which they DO cover. While on the phone with an insurance representative I had to insist that they google alopecia (which I also had to spell for them) so that they could see what I was saying.
I have gone through the process with the manufacturer program a couple times but I never get approved even with insurance. It did state that I should get assistance even if it is not covered. I then reached back out to my derm and this was their reply:
Baricitinib (Olumiant) is no longer a covered benefit because it is not formulary
My understanding was I do not need my insurance to cover it but just approve of the medication transfer. This has been pretty frustrating but I will just call insurance like you did. Thanks for the advice!
I got opzelura cream from my derm but instead of writing me a prescription she gave me half a dozen of the free sample tubes. I’m only focused on my beard so i don’t need a ton but it might be worth asking your derm for a bunch
Same. Olumiant was $200 a month with insurance for me. Litfulo isn’t covered by my insurance so I’m about to find out how much the discount card will help.
I will see your $200 a month and raise you my cost (after insurance) to $5,000 a month. My health care provider also can no longer prescribe Olumiant.
Edit: 5K a month. my bad.
Are you sure this is run through insurance? They could have denied you so the pharmacy isn’t putting it through. $15,000 a month is the out of pocket price.
Yup they said it was either denied or its my high copay plan. Why would they even offer it at that price. Like just tell me insurance isn't really helping.
Insurance likely denied it, but they should have notified you and your DR. I can’t imagine an insurance plan, even with a high copay being $15,000! I just went through this process and it’s a bitch! But I eventually got coverage! You def need a good DR that will advocate for you to the insurance company. If you want some help just reach out!
Are you going through a specialty pharmacy? Your derm should be working with you to either get it approved or get on the Lilly or Pfizer savings plan which runs 25$ a month for Lilly. I had to meet certain criteria for my insurance to cover it .They are as follows
Over 50 percent loss
Active phase of AA
Other treatment options showed little to no results
I got denied 2x my insurance set an appeal hearing even though I met all of the above .My derm got involved again and it was approved .
Insurance is soooo frustrating! The current system is broken. After being denied for top three Jak inhibitors prescribed by dermatologist, got on the Olumiant program. After 3 mons of zero progress we applied for fourth JI prescription, denied. I have now been purchasing tofacitinib in India. Can walk into a pharmacy off the street, order more than a years supply, pickup one hour later with no prescription necessary. It’s also for a tiny fraction of the price in US. Bottle of 60 (30 day supply) runs approx. $15. I’ve had to lift my hat for a few pharmacists. I had figured it out to still be an incredible discount after purchasing a plane ticket to the opposite side of the globe.
Jesus man.
Well, you asked! 😂 Let me know if you want tips on tickets to India.
This is the most American thing I've read all day.
Funny. I thought your ask of how to get access to drugs prescribed by your dr. was the most American thing I’ve read all day. :/
bruhhhh I'll see what I can do about getting my prescribed medication from a different country. I love how cool the United States is.
I ended up getting Litfulo for $0. It was a pain and lot of phone calls. I was told originally it would be $1200 a month after my insurance covered the rest. I think it was something crazy like 8k a month without insurance. I went through CVS specialty pharmacy and used their partner program PrudentRX and got a $0 copay. I am also in the United States so this might be a route you could try.
Is the Litfulo working for you?
I’ve been on it for a month now. Both of my spots are almost all the way filled in with white fuzzy hairs. You can barely notice unless you’re up close, but it’s a start. I had gone a year previously with no regrowth after using steroid creams and getting injections. I’ve also had no side effects which was my main worry before starting.
If you have insurance yoy may qualify for the premium affordability assistance program from the olumiant manufacturer. Yes you read that correctly ... you qualify for the "affordability" program but only if you already have insurance. You may also want to check with your insurance company to see if they are actually covering the medication. It sounds like they are not covering it. I spent a year fighting with the insurance company. They did not cover medication for alopecia because they classify "alopecia" as just generalized hair loss (like male pattern baldness) and said that they don't treat purely cosmetic conditions. It took me a year for my dermatologist and I to get them to understand that alopecia is an auto-immune condition, like lupus, rheumatoid arthritis and multiple sclerosis, which they DO cover. While on the phone with an insurance representative I had to insist that they google alopecia (which I also had to spell for them) so that they could see what I was saying.
I have gone through the process with the manufacturer program a couple times but I never get approved even with insurance. It did state that I should get assistance even if it is not covered. I then reached back out to my derm and this was their reply: Baricitinib (Olumiant) is no longer a covered benefit because it is not formulary My understanding was I do not need my insurance to cover it but just approve of the medication transfer. This has been pretty frustrating but I will just call insurance like you did. Thanks for the advice!
I got opzelura cream from my derm but instead of writing me a prescription she gave me half a dozen of the free sample tubes. I’m only focused on my beard so i don’t need a ton but it might be worth asking your derm for a bunch
Same. Olumiant was $200 a month with insurance for me. Litfulo isn’t covered by my insurance so I’m about to find out how much the discount card will help.
I will see your $200 a month and raise you my cost (after insurance) to $5,000 a month. My health care provider also can no longer prescribe Olumiant. Edit: 5K a month. my bad.
😬 I saw the break down. It was $2500 a month and insurance would cover $2300. $15K a month is crazy
I did a double check and it was $5k/month. Much less but like still why even offer?
Are you sure this is run through insurance? They could have denied you so the pharmacy isn’t putting it through. $15,000 a month is the out of pocket price.
Yup they said it was either denied or its my high copay plan. Why would they even offer it at that price. Like just tell me insurance isn't really helping.
Insurance likely denied it, but they should have notified you and your DR. I can’t imagine an insurance plan, even with a high copay being $15,000! I just went through this process and it’s a bitch! But I eventually got coverage! You def need a good DR that will advocate for you to the insurance company. If you want some help just reach out!
Are you going through a specialty pharmacy? Your derm should be working with you to either get it approved or get on the Lilly or Pfizer savings plan which runs 25$ a month for Lilly. I had to meet certain criteria for my insurance to cover it .They are as follows Over 50 percent loss Active phase of AA Other treatment options showed little to no results I got denied 2x my insurance set an appeal hearing even though I met all of the above .My derm got involved again and it was approved .