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Gilenya For discussing the first oral disease modyfying drug, Gilenya.

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  #1  
Old 01-06-2011, 09:28 AM
arjay arjay is offline
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Cost of Gilenya

I was on Avonex but it wasn't working. A recent MRI showed a lot of new lesions, so my physician is now recommending this new oral medication.

About how much does it cost?

Thank you!
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  #2  
Old 01-06-2011, 12:27 PM
Just a small town girl Just a small town girl is offline
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The quoted cost without any insurance coverage is $4,000 every 28 days. However, most insurance will cover it. For me my coverage would be the same regardless of what MS drug I take: I'm responsible for a 25% co-pay that maxes out at $2,500 a year. So I'll pay $2,500 a year for it (the same as what I would pay for any of the other MS drugs). Most people that I've seen have lower co-pays at least percentage wise but not sure they have a cap. What I would do is call your insurance company and ask what it would get charged at. (Also some of the specialty pharmacies charge less than the full $4,000 for the drug.)

Hope this helps in any way.
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  #3  
Old 01-06-2011, 01:03 PM
arjay arjay is offline
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Thanks, that really is helpful.

I was just doing some reading on this and $48,000 is shocking. I feel guilty even asking my insurance company to pay for it -- it will be a disaster for them.
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  #4  
Old 01-06-2011, 02:17 PM
Just a small town girl Just a small town girl is offline
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I understand that feeling. I mean how is any drug really worth just under $150 per pill? But I don't the government is ever going to stop pharma from setting their own prices so what can you do?

What really irks me is that Genzyme is thinking about providing their drug Campath for free to cancer patients, so Genzyme can jack up the price for a smaller amount of the same drug to MS patients.

Novartis' pricing decision seems outrageous, but really it seems that way with just about all of them.
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  #5  
Old 01-09-2011, 11:15 AM
lac4x9 lac4x9 is offline
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Quote:
Originally Posted by arjay View Post
Thanks, that really is helpful.

I was just doing some reading on this and $48,000 is shocking. I feel guilty even asking my insurance company to pay for it -- it will be a disaster for them.
You need to get over that guilty feeling. Trust me, $48,000 is a very tiny drop in the bucket for insurance companies.
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  #6  
Old 01-22-2011, 08:20 PM
Abby Abby is offline
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I just ordered a three month refill of Gilenya through MEDCO and the listed cost that my insurance plan pays is $11,543.08. My co-pay for the three months is $60.00.
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  #7  
Old 01-22-2011, 08:53 PM
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Quote:
Originally Posted by Abby View Post
I just ordered a three month refill of Gilenya through MEDCO and the listed cost that my insurance plan pays is $11,543.08. My co-pay for the three months is $60.00.
Yep that sounds about right, it should be about $4000 per 28 day pack.
I am truely blessed to have the health insurance I have, I pay $9.00 for 3 packs. (military insurance)
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  #8  
Old 01-24-2011, 12:12 PM
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$3,957.22

Way Too Much! My insurance was billed $3,917.22 & I only paid $40 co-pay for 28 pills.
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  #9  
Old 01-24-2011, 03:05 PM
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tombo131 tombo131 is offline
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My insurance (United Health) uses CVS Caremark for their prescription plans. My plan pays 80% with a co-pay of 20% until I hit an out of pocket maximum of $1500 per year. My co-pay for my first shipment of Gilenya would have been $760 but I was approved for the Novartis Co-Pay Assistance program - they are picking up the co-pay!
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  #10  
Old 01-24-2011, 05:36 PM
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CrazyCatLady CrazyCatLady is offline
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Quote:
Originally Posted by tombo131 View Post
My insurance (United Health) uses CVS Caremark for their prescription plans. My plan pays 80% with a co-pay of 20% until I hit an out of pocket maximum of $1500 per year. My co-pay for my first shipment of Gilenya would have been $760 but I was approved for the Novartis Co-Pay Assistance program - they are picking up the co-pay!
Wonderful!!!!!!
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  #11  
Old 02-07-2011, 02:33 PM
ccsitter ccsitter is offline
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anyone

cost of gilenya insurance blue cross blue shield of texas would I call the ins. co. to see what they would pay if any
We have a 8,000.00 out of pocket before they pay anything

also should I check with my pcp bout starting it since I do have copd read up on gilenya poss. breathing problems
concerned with this side effect.

Apreciate any info yall can give me Thank you have a wonderful day and GOD BLESS
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  #12  
Old 02-07-2011, 10:32 PM
Just a small town girl Just a small town girl is offline
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Originally Posted by ccsitter View Post
cost of gilenya insurance blue cross blue shield of texas would I call the ins. co. to see what they would pay if any
We have a 8,000.00 out of pocket before they pay anything
It sounds like you talked to someone who might actually know what they're talking about, but you might want to double check. I called Anthem BCBS three different times and got three different answers (no coverage, coverage with $30 co-pays and coverage with us paying 25% that's capped at $2,500 a year).

If it were me I would probably call again just to verify that this is indeed what your plan requires (to double check you can ask them to run a test prescription through, I know they can do it because the claims person I talked to did).

Quote:
Originally Posted by ccsitter View Post
also should I check with my pcp bout starting it since I do have copd read up on gilenya poss. breathing problems concerned with this side effect.
I was unaware of the breathing side effects until just recently. With COPD I would definitely talk with both your PCP and Neuro about this. You probably also want to find out how they would plan to treat any respiratory infections, bronchitis, etc. You also might want to get a guesstimate on recovery times.
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  #13  
Old 03-04-2011, 10:15 AM
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Scooter24 Scooter24 is online now
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payment assistance for Gilenya

see this link regarding thier policy for assistance
http://www.fiercepharma.com/story/no...lls/2010-10-07
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  #14  
Old 03-04-2011, 11:35 AM
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Quote:
Originally Posted by Abby View Post
I just ordered a three month refill of Gilenya through MEDCO and the listed cost that my insurance plan pays is $11,543.08. My co-pay for the three months is $60.00.
$20 a month fits everybody's budget.
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  #15  
Old 03-04-2011, 01:07 PM
laurasari laurasari is offline
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I called Empire bcbs. They said it is not formulary and therefore would require the dr filling out pre auth forms and then if it is approved then they could give me a cost not now.
I can't start till may so i wont no till then what i am doing. I first have to b off Ty for 3 months so i will be starting Copaxone till i can start Gilenya.
laurie f
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