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How Will I Pay For My MS Medications?

Being diagnosed with Multiple Sclerosis is not only a difficult diagnosis to handle, it is also an expensive one.  Knowing how to pay for your medication is an important, and often daunting task as treatment costs continue to skyrocket.

How can we pay for our medication if we are unemployed?  If we have private health insurance, what will our copay and deductible be?  What will our out of pocket expenses be?  What is our Medicare “donut hole”?

I have been taking Copaxone since it was first FDA approved 17 years ago.  I remember what the cost for Copaxone was back then, but somehow I lost track of its cost today.  For the purpose of this article, I was curious about today’s cost for all of the FDA approved MS medications.  The answers I found were astounding.

According to MedCity News1 (which only discussed a couple of MS drugs), Biogen charges $54,900 a year for its newly approved oral medication, Tecfidera, and the cost for rival Teva Pharmaceutical Industries’ drug, Copaxone, is the same.  Novartis AG charges $60,000 a year for its oral drug, Gilenya, and Sanofi charges $48,000 for its treatment, Aubagio.

The website also quotes the research firm ISI as believing that Biogen Idec will charge $51,000 for Tecfidera, while Teva will reportedly charge $50,000 a year for Copaxone.

How will we pay for the medications we need?

There are ways to find some assistance.

If you have private health insurance, or get insurance through your employer, speak with an insurance representative.  (Many MS Center’s know there is usually a social worker on hand who can help with insurance matters.)

Also, know your rights under The Affordable Care Act.  In 2014 people with pre-existing conditions can no longer be denied health insurance. Many uninsured people living without health insurance will now have access to coverage.

The National Multiple Sclerosis Society2 provides all of the information you need to become knowledgeable about ACA, and how it applies to your MS.  It is stated that, “Uninsured people with pre-existing conditions, including MS, who have been without insurance for six months or more may buy a health plan through the Pre-Existing Condition Insurance Program (PCIP), which has established temporary high risk pools.” Additionally, “as of July 2011, the cost of this coverage is going down in many states.”

Here are some other ways to find the help you need:

  • The National Multiple Sclerosis Society has a financial assistance program to help guide and support you in finding ways to pay for your prescriptions.  Give them a call at 1-800-344-4867 to speak to an MS Navigator, or visit their website at www.nmss.org.  Your local chapter will be more than happy to assist you.
  • Many pharmaceutical companies have financial assistance programs and are ready to speak with you about your specific needs.  The National Multiple Sclerosis Society offers a page of information about each company, and where you can find answers to your questions.  Be sure to take a look at it.
  • If you are presently on Medicare and need help, you can see if you qualify for extra assistance through their Medicare Prescription Coverage.  Check out The National Council on Aging for more information.
  • There are some national foundations that provide help for people with MS. They include NeedyMeds, The Patient Access Network Foundation and Chronic Disease Fund.
  • Social Security Disability Insurance is available for people who are unable to work, but are entitled to receive disability benefits.  Once again, The National Multiple Sclerosis Society will help you better understand the maze of getting approved for SSDI.

You are not alone in finding ways to pay for your MS medications.  As always, we are for you at MultipleSclerosis.net.

This article represents the opinions, thoughts, and experiences of the author; none of this content has been paid for by any advertiser. The MultipleSclerosis.net team does not recommend or endorse any products or treatments discussed herein. Learn more about how we maintain editorial integrity here.

1. http://medcitynews.com/2013/04/new-copaxone-rival-costs-55000/ 2. http://www.nationalmssociety.org/government-affairs-and-advocacy/affordable-care-act-resources/index.aspx

Comments

  • Q
    1 year ago

    When I was prescribed my first medication (Rebif) I mentioned that I wouldn’t be able to afford the copay on my insurance to my doctor. She made sure to give my info to MS One to One, which is a patient support group for Rebif patients. They also covered my copay the whole time I took Rebif. And when I was switched to Aubagio, their support group does the same thing.
    Make sure you know who is representing you in Congress. If ACA goes away, a lot of MSers stand to lose.

  • ShootingStar
    5 years ago

    The Chronic Disease Fund is not covering MS medications or accepting applications as of 6 Dec 2014.

  • DianeD
    6 years ago

    I’m sorry to be a negative voice here, because I know so many people are looking for a way to pay for medications.

    Just want folks to be aware that, like so many things promised by the AFA, the options are there, you can’t be turned down, but you CAN be charged more due to pre existing conditions. I can only get insured by one provider in my State due to my MS. I am on Soc.Sec. as I’m over 65. However I found out I’m only able to receive coverage for my DMD under one provider. I am at the mercy of that provider as to how much the rates change.

  • Traumaemt
    6 years ago

    But beware…. I joined a “high risk” state pool after I had to retire due to my MS, and waiting for my SSDI to kick in, and I still had to wait 90 days for my pre-existing conditions to be covered. So check your “high risk” pool terms. There may be hidden wait periods. Also, as I was applying for regular insurance, I was not denied for my MS, I was denied for my “Height to Weight Ratio is to high”. That is how they are getting around the pre-existing condition mandatory coverage. Just some heads up!!

  • Joanne
    6 years ago

    I am also unemployed. But there is more help. If you are a member of Kaiser they have a financial assistance program you can apply for, In addition I was on AVONEX and they also have a program to help. Between the two of them my cost was zero. Now I am about to start Copaxone and Kaiser is still picking up the cost. Not sure how this will all pan out when I do go back to work. But I wanted you all to know you need to ask for help and see if they have programs to assist. Joanne

  • Sonya
    6 years ago

    Cathy,
    As always, another information filled article.
    While this isn’t something I need today, one never knows about tomorrow. My husband is a retired federal employee, & we are living on one retirement income. It is certainly up for debate, as to what will happen to their insurance in years to come. If they end up paying a much larger percentage of the insurance premium, it takes away from what we are financially capable of paying, for meds.
    Thanks for all you do to keep us informed.
    Sonya

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