Otezla Help Ideas

[sman]

AI says this:
It appears that WellCare has designated Otezla as a Tier 5 drug, which means it is a non-preferred drug. It is possible that the client has been directed to purchase the drug through Amazon Pharmacy because it is a less expensive option than purchasing through a traditional pharmacy. It's unclear how the claim would be processed in this scenario, it's possible that WellCare would still process the claim and the cost would be adjudicated through the client's insurance plan.

It's important to shop around and compare prices at different pharmacies, and also check with the insurance company if they have any preferred or contracted pharmacies. Additionally, the client may also want to check if there are any patient assistance programs or manufacturer coupons that can lower the cost of the medication.

AI didn't get it quite right. A Tier 5 medication is a Specialty medication (as are most of these newer medications for auto-immune disorders). On most plans, you pay a percentage of the retail price for a Specialty medication (usually in the range of 25%-33% as it varies by plan). So the lower the retail price you can find, the better, but I doubt it will make a huge difference in her cost. I don't think Otezla is available at just any pharmacy though, so your client is likely limited on where she can purchase it.

The good news, if you can consider it good news, is that she will blow through the coverage gap rather quickly and hit the catastrophic phase where she will then pay no more than 5% of the cost.

 

[somarco]

No assistance at PAN for Otezla but thanks.

Don't know the disease treated . . . flipped a coin and went the psoriatic arthritis.



The fund for Psoriatic Arthritis is closed.

We don't have an open fund available for Psoriatic Arthritis, but we still may be able to help.

Sign up for the wait list

[EXTERNAL LINK] - Apply for assistance - PAN Foundation

Is this what you ran into?



I have clients that signed up for the wait list (different med, same foundation) and were notified a few weeks later of an opening. I would not expect an opening that quickly, but doesn't hurt to try.

 

[Duaine]

Don't know the disease treated . . . flipped a coin and went the psoriatic arthritis.



The fund for Psoriatic Arthritis is closed.

We don't have an open fund available for Psoriatic Arthritis, but we still may be able to help.

Sign up for the wait list

[EXTERNAL LINK] - Apply for assistance - PAN Foundation

Is this what you ran into?



I have clients that signed up for the wait list (different med, same foundation) and were notified a few weeks later of an opening. I would not expect an opening that quickly, but doesn't hurt to try.

Thanks I will have her try that also.

 

[Brande]

Have you tried the patient assistance program from Amgen? Here is what is says about the part D folks:


I would definitely try the phone line, those reps are pretty helpful. If they are approved they will probably ship it to the client for free for 12 months.

 

[Duaine]

Thanks Brande.