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Post by Deleted on Dec 7, 2015 20:22:55 GMT -5
It depends on the box you get. The higher doses are more expensive but around 400$ a box before insurance coverage. Each box contains 90 cartridges. My dad had been paying 240.$ a month after insurance for 2 boxes(120$ per box). That is tier 4 coverage on his Medica part D.. however after the 1st of the year it has been removed from the formulary all together in favor of injectable insulin. In addition to the discount programs, Sanofi may be able to offer your father additional help based on his financial situation. May be worth a call to them and ask. Most drugs have patient assistance programs to reduce cost.
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Post by kdaddyfresh2000 on Dec 7, 2015 20:29:41 GMT -5
It depends on the box you get. The higher doses are more expensive but around 400$ a box before insurance coverage. Each box contains 90 cartridges. My dad had been paying 240.$ a month after insurance for 2 boxes(120$ per box). That is tier 4 coverage on his Medica part D.. however after the 1st of the year it has been removed from the formulary all together in favor of injectable insulin. Is that Nationwide that Medicare Part D dropped Afrezza? Isn't this a huge setback for us since most or a lot of seniors rely on this?! Not even Tier 4? I don't know enough about senior Medicare for perspective... Can someone explain if they know...
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Post by liane on Dec 7, 2015 20:31:22 GMT -5
sweedee79, Did he consider switching part D plans? Open enrollment ends today.
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Post by sweedee79 on Dec 7, 2015 20:38:11 GMT -5
It depends on the box you get. The higher doses are more expensive but around 400$ a box before insurance coverage. Each box contains 90 cartridges. My dad had been paying 240.$ a month after insurance for 2 boxes(120$ per box). That is tier 4 coverage on his Medica part D.. however after the 1st of the year it has been removed from the formulary all together in favor of injectable insulin. Is that Nationwide that Medicare Part D dropped Afrezza? Isn't this a huge setback for us since most or a lot of seniors rely on this?! Not even Tier 4? I don't know enough about senior Medicare for perspective... Can someone explain if they know... My dad has his insurance in Minnesota. Each state has its own rules I guess so I don't know about what other states are doing.. Our pharmacy searched every part D plan in Minnesota and they either don't cover it or have removed it from their formulary. I would guess this is due to the higher expense. They can get by with it because it is a new drug considered a specialty drug by most insurance plans and not necessary when they already have injectable insulin which they seem to believe is an equal option.
I am going to call SNY and inform them of what has happened for their info. ... But it took us 5 months just to get a doc to prescribe it and get the tier 4 coverage we had... then the docs wouldnt raise his dose as was obviously needed... and honestly while my dad thinks it is superior... he is just tired of the hassle. He is going to wait until Afrezza has established itself and then yes he will most definitely ask for it again.
I believe the non inferior status hurts insurance coverage....
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Post by dreamboatcruise on Dec 7, 2015 20:54:36 GMT -5
Is that Nationwide that Medicare Part D dropped Afrezza? Isn't this a huge setback for us since most or a lot of seniors rely on this?! Not even Tier 4? I don't know enough about senior Medicare for perspective... Can someone explain if they know... My dad has his insurance in Minnesota. Each state has its own rules I guess so I don't know about what other states are doing.. Our pharmacy searched every part D plan in Minnesota and they either don't cover it or have removed it from their formulary. I would guess this is due to the higher expense. They can get by with it because it is a new drug considered a specialty drug by most insurance plans and not necessary when they already have injectable insulin which they seem to believe is an equal option.
I am going to call SNY and inform them of what has happened for their info. ... But it took us 5 months just to get a doc to prescribe it and get the tier 4 coverage we had... then the docs wouldnt raise his dose as was obviously needed... and honestly while my dad thinks it is superior... he is just tired of the hassle. He is going to wait until Afrezza has established itself and then yes he will most definitely ask for it again.
Not good news... both for people needing Afrezza in MN and for shareholders. Formularylookup.com lists 9% of Medicare plans in MN covering Afrezza, but that may still be 2015 data. I checked and a couple of the supposedly covered plans are from Express Scripts... so I went to their site and used their search tool to find plans that cover particular drugs. I used a St. Paul zip code... sadly, no plans seemed to cover Afrezza since the prices they gave amounted to around $3500/yr for the Afrezza cost. So either the formularylookup.com data is simply wrong, or this is the case that some insurers that had coverage are now dropping it
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Post by sweedee79 on Dec 7, 2015 20:57:01 GMT -5
My dad has his insurance in Minnesota. Each state has its own rules I guess so I don't know about what other states are doing.. Our pharmacy searched every part D plan in Minnesota and they either don't cover it or have removed it from their formulary. I would guess this is due to the higher expense. They can get by with it because it is a new drug considered a specialty drug by most insurance plans and not necessary when they already have injectable insulin which they seem to believe is an equal option.
I am going to call SNY and inform them of what has happened for their info. ... But it took us 5 months just to get a doc to prescribe it and get the tier 4 coverage we had... then the docs wouldnt raise his dose as was obviously needed... and honestly while my dad thinks it is superior... he is just tired of the hassle. He is going to wait until Afrezza has established itself and then yes he will most definitely ask for it again.
Not good news... both for people needing Afrezza in MN and for shareholders. Formularylookup.com lists 9% of Medicare plans in MN covering Afrezza, but that may still be 2015 data. I checked and a couple of the supposedly covered plans are from Express Scripts... so I went to their site and used their search tool to find plans that cover particular drugs. I used a St. Paul zip code... sadly, no plans seemed to cover Afrezza since the prices they gave amounted to around $3500/yr for the Afrezza cost. So either the formularylookup.com data is simply wrong, or this is the case that some insurers that had coverage are now dropping it I have used formulary lookup and it isn't reliable. Ive searched high and low ... no part D coverage for Afrezza in Minnesota...
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Post by kball on Dec 7, 2015 21:01:23 GMT -5
Is that Nationwide that Medicare Part D dropped Afrezza? Isn't this a huge setback for us since most or a lot of seniors rely on this?! Not even Tier 4? I don't know enough about senior Medicare for perspective... Can someone explain if they know... My dad has his insurance in Minnesota. Each state has its own rules I guess so I don't know about what other states are doing.. Our pharmacy searched every part D plan in Minnesota and they either don't cover it or have removed it from their formulary. I would guess this is due to the higher expense. They can get by with it because it is a new drug considered a specialty drug by most insurance plans and not necessary when they already have injectable insulin which they seem to believe is an equal option.
I am going to call SNY and inform them of what has happened for their info. ... But it took us 5 months just to get a doc to prescribe it and get the tier 4 coverage we had... then the docs wouldnt raise his dose as was obviously needed... and honestly while my dad thinks it is superior... he is just tired of the hassle. He is going to wait until Afrezza has established itself and then yes he will most definitely ask for it again.
I believe the non inferior status hurts insurance coverage....
I feel the need to again mention the survey by Towers Watson that claimed currently SPECIALTY DRUGS aren't on 53% of formulary's...with that number CLIMBING TO 85% by 2018. I honestly think this is the biggest reason to be very worried unless Afrezza somehow isn't considered a specialty drug soon
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Post by dreamboatcruise on Dec 7, 2015 21:23:54 GMT -5
kball... we're sitting ducks for the shorts with the common knowledge that formularies are year by year throwing more drugs off, and yet we've got absolutely zero info on when/how SNY is going to address this access issue.
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Post by sweedee79 on Dec 7, 2015 21:27:29 GMT -5
My dad has his insurance in Minnesota. Each state has its own rules I guess so I don't know about what other states are doing.. Our pharmacy searched every part D plan in Minnesota and they either don't cover it or have removed it from their formulary. I would guess this is due to the higher expense. They can get by with it because it is a new drug considered a specialty drug by most insurance plans and not necessary when they already have injectable insulin which they seem to believe is an equal option.
I am going to call SNY and inform them of what has happened for their info. ... But it took us 5 months just to get a doc to prescribe it and get the tier 4 coverage we had... then the docs wouldnt raise his dose as was obviously needed... and honestly while my dad thinks it is superior... he is just tired of the hassle. He is going to wait until Afrezza has established itself and then yes he will most definitely ask for it again.
I believe the non inferior status hurts insurance coverage....
I feel the need to again mention the survey by Towers Watson that claimed currently SPECIALTY DRUGS aren't on 53% of formulary's...with that number CLIMBING TO 85% by 2018. I honestly think this is the biggest reason to be very worried unless Afrezza somehow isn't considered a specialty drug soon I haven't heard of that survey but will check it out... thanks.. I think the cost of drug coverage is becoming an issue for insurance companies particularly part D plans providing for seniors whom have more needs. ... My mother was on the drug Forteo for osteoporosis .. its cost before insurance was 2500$ a month . and she had to be on it or break bones .. it is the only drug of its kind that builds bone density significantly. There are some drugs that are astronomical in price so insurance companies are trying to cut wherever they can. This issue has come up in political arenas lately as a concern for future health care and the cost. I am looking more and more toward Afrezza being approved and marketed in other countries as well .. It is just an amazing drug... but the label imposed by the FDA really undercuts the superiority of it .. MND and SNY have to get this going a bit faster if possible.. I hope their plans will materialize soon...
Also lets not forget that SNY is trying to get Afrezza approved for use in children which could be a huge draw because kids are afraid of needles...
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Post by mssciguy on Dec 7, 2015 21:30:35 GMT -5
sweedee79 maybe you should contact mnholdem, he's in Minn, may know some things that could help
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Post by kball on Dec 7, 2015 22:03:49 GMT -5
I feel the need to again mention the survey by Towers Watson that claimed currently SPECIALTY DRUGS aren't on 53% of formulary's...with that number CLIMBING TO 85% by 2018.I honestly think this is the biggest reason to be very worried unless Afrezza somehow isn't considered a specialty drug soon I haven't heard of that survey but will check it out... thanks.. I think the cost of drug coverage is becoming an issue for insurance companies particularly part D plans providing for seniors whom have more needs. ...
Article here: Correction...Restricted rather than 'aren't on' formularies www.cnbc.com/2015/11/12/companies-coutinue-chipping-away-at-health-insurance-benefits.html
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Post by compound26 on Dec 7, 2015 23:54:57 GMT -5
Note that Sam (Sam on Tudiabetes.org, not Sam Finta) uses less than one box in one month (he says one box will last 1.5 months for him). That is atypical. Most Afrezza users use more than that. Sam Finta uses about two boxes a month and I think at some time Laureen indicated that she uses 9 boxes for three months. In another tweet she mentioned she got a refill for 90 days for 7 boxes. I would roughly estimate that generally a user will probably need two boxes of Afrezza per months. That would reasonable as a 90 cartridge only gives you one cartridge for each meal. Since you will naturally need additional units for snacks and follow-up doses, two boxes per month would seem to be the right (average) number. In that case, the average cost will be much higher (than $159 as indicated by Sam on Tudiabetes.org), if not covered by insurance. This is because the Sanofi savings card is limited to one box per prescription/refill. So if you need two boxes per month, without insurance, the cost will be $380+ (say if you get two boxes of 90 x 4Us at Costco without insurance) or somewhere around $400. Note that you do NOT need to be a member at Costco to purchase Rx products at their stores or via their online (mail order) pharmacy. The only issue with online (mail order) is if your Rx plan has a mandated mail order pharmacy. For those that do not have insurance, Costco and the Sanofi discount card is a great idea and even more important as we all wait for formulary coverage to improve. Compound, any chance you can put some type of streaming banner ad on your blog about the above?
scotta: I understand Costco's price of Afrezza to be lower than the other pharmacies, but only slightly. AS indicated by the following comparison: www.goodrx.com/afrezzaI will add a link on the blog to goodrx.com indicating it as a resource to compare the price of Afrezza.
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Post by suebeeee1 on Dec 8, 2015 0:00:57 GMT -5
I'll take restricted....happily....over denied!
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Post by peppy on Dec 8, 2015 8:09:53 GMT -5
My dad has his insurance in Minnesota. Each state has its own rules I guess so I don't know about what other states are doing.. Our pharmacy searched every part D plan in Minnesota and they either don't cover it or have removed it from their formulary. I would guess this is due to the higher expense. They can get by with it because it is a new drug considered a specialty drug by most insurance plans and not necessary when they already have injectable insulin which they seem to believe is an equal option.
I am going to call SNY and inform them of what has happened for their info. ... But it took us 5 months just to get a doc to prescribe it and get the tier 4 coverage we had... then the docs wouldnt raise his dose as was obviously needed... and honestly while my dad thinks it is superior... he is just tired of the hassle. He is going to wait until Afrezza has established itself and then yes he will most definitely ask for it again.
Not good news... both for people needing Afrezza in MN and for shareholders. Formularylookup.com lists 9% of Medicare plans in MN covering Afrezza, but that may still be 2015 data. I checked and a couple of the supposedly covered plans are from Express Scripts... so I went to their site and used their search tool to find plans that cover particular drugs. I used a St. Paul zip code... sadly, no plans seemed to cover Afrezza since the prices they gave amounted to around $3500/yr for the Afrezza cost. So either the formularylookup.com data is simply wrong, or this is the case that some insurers that had coverage are now dropping it $3500/yr for the Afrezza cost. $9.58 per day. May I ask, What unit combination? www.afrezzapro.com/afrezza-configurations Any spares for second dose?
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Post by mssciguy on Dec 8, 2015 8:27:21 GMT -5
Not good news... both for people needing Afrezza in MN and for shareholders. Formularylookup.com lists 9% of Medicare plans in MN covering Afrezza, but that may still be 2015 data. I checked and a couple of the supposedly covered plans are from Express Scripts... so I went to their site and used their search tool to find plans that cover particular drugs. I used a St. Paul zip code... sadly, no plans seemed to cover Afrezza since the prices they gave amounted to around $3500/yr for the Afrezza cost. So either the formularylookup.com data is simply wrong, or this is the case that some insurers that had coverage are now dropping it $3500/yr for the Afrezza cost. $9.58 per day. May I ask, What unit combination? www.afrezzapro.com/afrezza-configurations Any spares for second dose?
Brandicourt got a $4.5 million sign on bonus in Feb of this year... sickening. Wow. I thought bonuses were for a job well done. Sanofi is reckless.
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