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High copay for Symbecort HFA

I am on Medicare and supplemental.  $387.00 copay not affordable.  My Dr. is appealing 3 teir status.  No choice but go off meds.  This is so unfair!  Any way out of this mess?

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  • Kathy P

    Hi and welcome Annette. Are there any other options in the meantime while your doc appeals? Does he have samples? Is there a different, similar med you can try that might be less expensive!

  • Annette

    My Dr. gives me samples she has on hand. I have talked to her aboutoptions but the lower doses are not what she wants me to take. Waiting forappeal from Humana. The Symbecort ads for coupons are not an option forMedicare. Seems to me we need it and are shut out because of "agreements"!Very frustrating and no one carries our cause!AnnetteOn Mon, Mar 26, 2018, 10:49 PM Asthma and Allergy Foundation of America <support@aafa.org> wrote:

  • Kathy P

    It's very frustafrust that the coupons don't work for non-commercial insurance. 

  • Pljohns

    I really think the coupons should work for Medicare as well.  Fixed income people have the hardest time affording medicine and can use all the help they can get and the coupons would certainly help.

  • K8sMom2002

    Annette, hugs … that IS frustrating! I hope the appeals are quick and successful!

    While you're waiting, have you checked out AAFA's resource page for folks who need help with their medications and co-pays? You may be eligible for help through other . There are some non-profit organizations which may be able to provide assistance to folks on Medicare. 

    is another possibility — you might not be able to get the exact same medication, but your doctor may be able to figure out a different one that works for you.

    AAFA also offer tips on what to do  medicines. Hopefully your doc will be able to provide you samples until you can come up with a long-term solution. 

  • Annette

    My Asthma Dr. Just called to say my Insurance company has granted my waverfor my Symbecort $389.00 co-pay! I have no idea how much my co-pay hasbeen reduced, but I am so thankful for this news!On Tue, Mar 27, 2018, 11:15 AM Asthma and Allergy Foundation of America <support@aafa.org> wrote:

  • Annette

    After several conversations with Humana I found that my doc needed to submit paperwork "proving" my need for Symbecort.  When I picked up my next script I almost fainted when the pharmist said, "your co-pay is $4.00"  thank you Dr. T.  So thankful!

  • Huffandpuff

    Hello. Didn't know where to post so will go here.

    I'm told by doctor that I have asthma, but never sent to specialist.

    This past week I got something.  Temp 102, stuff in bronci.

    Given albuterol for my nebulizer, steroids and cipro.

    Told asthma getting worse and maybe a daily steroid, 

    Breathing in would be better than pill.

    Problem is I have high ductable insurance ($6500).

    And not on Medicare or medicade.

    What do you find to be the most in expense, steroid

    Inhaler/nebulizer ,?

    Thank you

     

  • Melissa G

    Hi Huffandpuff! Welcome to AAFA! 

    It is hard to say as our insurance plans are all different. You doctor can give you scripts for different medications and you can have pharmacies price them out for you. We have done that in the past. 

    Also here is a resource for 

  • Annette

    My Asthma Dr. submitted paperwork to my insurance company explaining why I "needed" to use Symbicort and when my husband picked up my order, the co-pay had dropped to $4.00!  I need 2 other inhalers, but my co-pay is $335.00!  I am so tired of this, I just go without.

  • Melissa G

    Yikes Annette! That is a lot of money! I am so sorry you go without medication. How is your asthma?

  • K8sMom2002

    Annette, hugs … does your doc have any samples you can get? Could another letter be sent to the insurance company about the other inhalers? It's so important that people with asthma have access to their meds!

  • Pljohns

    Annette-are there any copay cards for your other 2 inhalers that you could use?

  • Annette

    Cards?  I have a card for one that says AI will not have to pay "over $150." And the second one had no discount offered.

  • LK

    I have had good luck asking our pharmacist if she knows of any discount or copay cards for my meds.  Several times she has been able to find discount cards for some of my pricier maintenance meds.  Worth asking about. 

    I have also found some discount/copay cards on the manufacturer's websites.

    Also, my pulmonary doctor's office has given me discount cards for some of my meds.

  • Pljohns

    Have you tried that one for the Sprivia

     

    Here's one for dymista too

     

    I don't know if they will help but wanted to give them to you

  • K8sMom2002

    Annette, any progress on the co-pays? I do hope your doctor was able to help you get your insurance company to reduce the co-pay.

    Another possibility … could you ask your pharmacist (and check at other area pharmacies) what the cost of the medications would be if you DIDN'T run it through your insurance? Sometimes on a rare, rare occasion, medications are actually cheaper that way than when you file a claim. It has to do with how the medications are categorized by the insurance.

    The downside is that it won't count as either out of pocket expenses or toward your deductible.

  • Annette

    Yes I got help from my Dr. She wrote a letter to Humana and a couple ofweeks later, my Dr.s office called to say the exception to Tier 3 had beengranted! My husband went to the pharmacy to pick up the Symbacort and myco-pay was $4.00! I am doing well, so thankful for the lower copay!Thank you for asking.Annette LunnonOn Thu, Oct 4, 2018, 8:01 PM Asthma and Allergy Foundation of America <support@aafa.org> wrote:

  • Pljohns

    Annette-that's wonderful!!!!  So many people don't realize they can appeal something not on their formulary.  There is a formulary exception form for all insurances-they just make it really hard to find because they don't want to pay for the meds but it is an option and we have the right to request that consideration.  So glad your copay was $4!!!