promacta - stress

I started on promacta about 3 years ago at age 63. I'm up to 75 mg from 25 mg. This med seemed to be the last resort. When I signed on to their access program I was low, fixed income and had no insurance. I just got insurance, the lowest cost available, with no deductible. I'm still very poor, no change there. When I called in my refill, I mentioned the insurance, and was promptly referred to the prom patient access program. There I was told in blunt terms that I would have to spend $600 on medications before receiving prom again at no additional cost. While I have no objection to paying a deductible, there is no way I can come up with $600. I'm angry that I was not informed about their policies re: insurance, deductibles. Nothing in the mail, no call. I'm a patient at a hospital where prom has been prescribed for me. My next heme appointment is at the hospital, and coming up in March. I can only hope that this issue can be resolved there. And oh, the prom folks referred me to another patient assistance program for patients who have issues with the prom patient access program. Honestly, I'm not optimistic at all about this.
My question is: has anyone here has had a similar experience? What kind of assistance/solution did you find?
Thanks! vega

I'm sorry you're having this issue.

I don't even completely understand my own insurance, and so I can't presume to unravel yours.
But maybe this will offer a possible alternative for you...
My own insurance pays for NPlate, but not so well for Promacta. It's because of the way they're billed. Because Promacta is a pill that the patient self-administers, it's billed under the drug portion of the plan. That means I'd be responsible for the copays as I would for any other drug picked up from a drugstore or mail order source.
But since NPlate, as an injectable, must be administered in a doctor's office, it's covered under the medical portion of the plan. As of now, I pay no copay for the drug itself, but the administration fee falls under the out-of-pocket expenses.
(That may or may not change come April, when I go on Medicare.)

So my advice is to check into that option.
Wishing you the best of luck with it.

I used Promacta for 3 years...worked great and only cost me $80 a month co-pay.
2 years ago insurances changes put an end to that. I did GSK's assistance program for a month, then everything got out of whack. If I used Promacta today it would cost me $5,000 co-pay for the annual max-out-of-pocket....total due the first month. Then I would have no payments for the rest of the year. But like so many of us, I can't afford that. So I had to make a choice.

I now take generic Cellcept at $10 a month and just live with counts in the 9k-16k range (21k is my highest in a year).


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Thank you very much! You are correct. As a hospital outpatient, Medicare covers and reimburses Nplate under part B, rather than than plan D (drug coverage). It seems to require detailed coding.
The site nplatehcp.com has detailed information about various reimbursements (in-patient, pharmacy, physician's office, including medicaid).
At beginning n-plate is administered each week via an injection. Eventually monthly injections will do.
Nplate seems to be the way to go. I am hopeful -

I was told there is another source of support for poor people on a fixed income, and independent foundation. I have not called.
Right now I hope that I can get n-plate covered by medicare part B.
What other medications have you tried besides cellcept?