![]() It is generally not counted as part of your deductible. This $3,700 does not come directly out of your pocket but is also not counted against your annual out of pocket max. You have copay assistance that will completely pay the $3,700 on your first refill. You are responsible for paying the first $2,000 in medical costs plus your co-insurance amount of 20-30% of the difference.The copay assistance does at least mean the pharma company has some direct eating of costs, so I still like to do it.ĭeductible is $2,000, out of pocket max is $6,000, starting day 1 of coverage, using co pay assistance, accurate amount billed to you for each refill is $3,700, Enbrel is the first medical cost you incur. I am a patient that always hits my out of pocket max, and so that is the amount I budget for each year in healthcare costs (plus all of the stuff that doesn't go through insurance of course). If you'll hit your $6,000 out of pocket max any way you spin it, the PPO style will simply drag out how long it takes you to hit that out of pocket max, but wouldn't change how much you actually pay assuming they have equivalent coverage. Many PPO plans will have your prescriptions have a A/B/C tier of copays for a 30 day supply of a drug, which dramatically reduces the amount you pay at the beginning, but it depends on the details for the math if you pay more one way or the other. This example assumes that your insurance covers the medication like all other medical costs and you have your deductible and co-insurance. Your deductible is then met, so your next month you'll just pay the co-insurance percent ($740-$1,110 as 20-30% of the copay), and continue to pay that until you hit your out of pocket max of $6,000.You pay the first 2,000 dollars of medical expenses - if Enbrel is first expense, then you'd pay $2,000 + the co-insurance % (likely 20-30%, 340-510) on $1,700 for a total of $2,340-$2,510.If, for example, your deductible is $2,000 and your out of pocket max is $6,000 and we start on day 1 of coverage (WITHOUT copay assistance), and the accurate billed amount to you is $3,700 per refill It's likely not as insanely high, although honestly not cheap either (maybe a third of that?). Still requires the prescription and it's more annoying than just picking it up at the neighborhood pharmacy, but potentially viable.Ģnd - I think there's some details that need working out with your situation and it's likely at least a bit better than you're thinking here.Ī couple of questions - what's your deductible (amount you pay before insurance pays anything)? out-of-pocket max (maximum you pay out of pocket, does not include copay assistance)?īig assumption - that the $3,700 is the amount you'll be billed after insurance every month. It's quite easy to buy medication from Canada and we can get you info on that if you need. Compared to the 5k my insurance wanted me to pony up before they'd pay anything, this was a potentially feasible option. When I looked 5 years ago they wanted $800 for a month's worth. Helpful resources:ġst- you can buy Enbrel in Canada. when sharing experiences with a certain (product/medicine/diet/etc), you must state HOW LONG you have been using said (product/medicine/diet/etc). The more context you give other users, the less misinformation is spread. Please provide as much detail when sharing your experiences with different treatments/diets/etc. Your doctor knows your situation best, and is a trained professional. However, be cautious before taking medical advice from anyone online. ![]() Surveys may be posted with mod approval on Mondays Subreddit guidelines:ĭon't be afraid to ask questions. Comments telling people to stop taking their medications will be removed and may result in a ban. Our personal doctors are the only people qualified to instruct us on what medications to take or stop taking. Don't instruct others to stop taking their prescription medication. Posting multiple text posts with the same content is not allowed. Posting the same link more than once is not allowed. Toxic, harmful, and oppressing comments will be removed. Any offences after this will result in a permanent ban. Multiple rule offences (moderator digression) will result in a 30 day ban. It eventually can cause the affected vertebrae to join together, effectively fusing the spine, which severely limits mobility. This is a place where patients, family, and friends of AS can find discussion, help, and support.Īnkylosing Spondylitis is a degenerative autoimmune disease, that is a form of inflammatory arthritis that mainly affects the lower back and hip joints. ![]()
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