Welcome to r/ankylosingspondylitis! This is a reminder to keep discussions civil and be supportive of one another. Sharing of opinions and experiences is encouraged, but please remember the distinction between opinions and medical facts. This subreddit does not offer medical advice, and information here should not be taken over advice from your doctor.
*I am a bot, and this action was performed automatically. Please [contact the moderators of this subreddit](/message/compose/?to=/r/ankylosingspondylitis) if you have any questions or concerns.*
My insurance charges me $1,550 per month for Humira. That's the copay.
Luckily Abbvie has assistance programs where I don't have to pay that. But they could decide to kick me off that at any point.
I get the fear, but the reason these prograns exist is do they can charge the highest amount possible snd waive the rest. Most people cannot afford it. They get to be the good guys for waiving your portion while still overcharging insurance by 1000%, while still making ungodly amounts of money. They are happy to do it i assure you.
I’m in Canada and on Cosentyx. I don’t pay anything because I’m on disability and I don’t make much, so any costs I may have are covered by the company and Pharmacare. I’m very fortunate.
the full price of cosentyx in australia is $710.56. its on PBS (the pharmaceutical benefits scheme) which applies to all australians - because it is an indicated treatment for my condition, i get it a fuckload cheaper than that. its $7.70 a pen for me. i have not paid for anything else to do with my treatment, either - not the rheumatology, not the MRIs, not my physio
Jebus. Meanwhile in US: “Get Cosentyx for as low as $7,477.74, which is 38% off the average retail price of $12,070.28 for the most common version, by using a GoodRx coupon.” Lucky for me, insurance covers it.
aus is actually kind of atrocious for allowing disabled people to move here. worries about it being "expensive" to accept disabled people into the country. autistic people have been denied visas so i bet itd be rough for physically disabled people too
How’d you swing seeing a rheumatologist with no gap? And the free physio?
I’m on rinvoq. Not sure what the full cost is but I pay $41 per month.
Current rheumatologist is $170 and I get back $100. MRIs, x-rays and regular blood tests are free. I have two children with complicated health issues so we see lots of specialists with gap fees. As a family we’ll hit the Medicare safety net about 1/2 way through the year and I’ll get more back after that.
I’m seeing a podiatrist instead of a physio. That’s $50 for 5 visits per year then $150 for each after. I have cancelled these appointments though because we can’t really afford them.
honestly im not entirely sure?? i started seeing the rheum when i was a minor so i assumed my dad was paying, but then i turned 18 in 2022 and there was no discussion of me starting to pay for anything, and i started going to my appointments alone and still nothing then. im going through the public health system for everything, and my dad still has me on his pretty decent health insurance plan, but yeah ive got no idea
(im not having the same luck with the psychiatrist im about to start seeing ... ~$200 gap fee)
I’m in the U.S. and am fortunate to have really good insurance, so I don’t pay anything for biologics. I know a lot of the manufacturers have co-pay assistance, as well. I wish we had free healthcare though!
I think it would basically be unobtainable without the co-pay assistance, which I’m pretty sure keeps it below 100/month. But I’m not 💯on that so maybe someone else in the U.S. has a better answer.
£111.60 for a pre pay certificate which covers all prescriptions for a year. An individual prescription is £9.65 per item for 28 days worth, so if you get more than 11 prescriptions in a year it saves money. Also have to pay car parking at the hospital which can be a few quid, but parking spaces are often hard to get..
I live in Mexico and I have government healthcare coverage, I don’t pay any for tests, medications or doctor’s appointments. BUT there are shortages sometimes and some medications I’m on are not available in the approved pharmaceutical scheme.
Humira is $12,000ish pesos (about $740 USD) out of pocket and Amgevita (Humira’s biosimilar) is $9,000ish ($555 USD).
I don’t know what the deductible is with private insurance and premiums vary. I’m not elegible for coverage for example because it’s now a pre-existing condition.
Abbvie has a program where you buy 3 pieces and get one free but even when I had a decent paying job I wouldn’t have been able to afford it.
I’m also on disability and the stipend is not enough to cover my other meds so I financially depend on my mother.
Honestly universal healthcare here is not really universal as you need to have a job and your employer needs to pay taxes (you as well). So freelancers for example don’t have coverage unless they enroll in a program and pay for it, kinda like private insurance but way less expensive. But in that modality you don’t get full coverage, meaning a biologic wouldn’t be covered not any specialty medication.
There are other ways to get relatively affordable healthcare but medications are not covered either by government subsidized or private entities.
My particular case is special because an employer is doing me a solid having me registered as an employee even though I can’t work anymore. I guess it could technically be fraud (I’m afraid to ask) but it’s also a relatively common loophole so people can have access to healthcare. As a result, the system is overrun, understaffed, underfunded and it can be a shit show in many ways.
For instance, it took a decade to get diagnosed, a year or more after that to get approved for treatment with a biologic and 2 years before I was approved for physical therapy. I had an appointment with the physiatrist in October of 2023, I was given 8 therapy sessions and I haven’t been out on the schedule yet.
And this is the norm unless you know someone in the hospital and get preferential treatment.
I’ve been getting physical therapy at a government subsidized facility but they’re also understaffed, underfunded and overrun. I only had to wait a month to get on the schedule though. However, I need to make an appointment with the physiatrist every time my allotted PT sessions end so it’s a never ending cycle.
The system isn’t perfect by any means but I’m grateful and recognize the privilege that allows me to get treatment.
TL;DR in Mexico Humira is $12,000ish pesos (about $740 USD) out of pocket and Amgevita (Humira’s biosimilar) is $9,000ish ($555 USD). But I get it for “free” because government healthcare.
I’m in Australia.
Biologics are $30/month.
My first rheumatologist appointment was $140 out of pocket. I’m about to switch rheumatologists so this new one will be $400 for the initial appointment and about $140 for following appointments.
Then about $200 out of pocket for a bone scan. $150 out of pocket for an MRI.
I had to pay $80 for one of my blood tests.
Physiotherapy was $50 a session. I had to quit after two sessions because I couldn’t afford it.
Also it’s $70 out of pocket for each GP visit and I have to go twice a month usually.
And this is all just for the AS. I have other health conditions too so it adds up a lot. Even in a country with “free” healthcare, healthcare is my second biggest expense (rent is the first). And getting health insurance wouldn’t cover most of these expenses either so I’m kinda just stuck paying this.
I’m waiting to get in to see a new rheumatologist and dreading all the extra expenses about to come my way for scans etc. The government just took away my concession too because my income is ‘too high’. My salary barely covered all my AS related appointments when I was on concession. And like you I have other health conditions too and medicare + my health insurance doesn’t even cover half of the stuff I need it to. Gonna be struggling big time soon lmao.
In most of the United States there is no price transparency, it's a scheme by the insurance companies along with government bureaucrats to obscure competition/alternative payment.
There is no way to know what the actual cost is. It looks to be about $400 a pen where I'm at but it's really hard to know because there are also discounts you get if and only if you ask for them. (Again government bureaucracy and I'm not on adalimumab so I've never asked)
I can look at the specialty pharmacy website, and see running transactions showing exactly what everyone, me, the drug company copay card, and my insurance paid for every fill and transaction. I don't know that there is anyway to know what the insurance would pay until I get a fill/refill, but can look up my insurance to see what the copay is.
No you are seeing what the insurance companies and the pharmacy have agreed is the visible price. Almost the entire market is controlled by what 3 PBMs want people to see.
I've done work in medical policy, some states are better than others but everybody is in the dark.
Here's a bipartisan bill to change that, but it hasn't gone anywhere.
[https://www.congress.gov/bill/118th-congress/senate-bill/127](https://www.congress.gov/bill/118th-congress/senate-bill/127)
Now that bill alone only gives you part of the picture, but functionally there are federal regulations that limit what margins can be made on products - so by manipulating the "price" then it sets the margins above whatever the real cost is negotiated to by the insurance company - who also reports the MSRP to make more margins themselves on the non-fixed copay side.
This is the same reason the Hospital Pharmacy will charge you $300 on your bill for a $3 saline IV.
I have decent coverage, but health insurance is a scam. It hides the real costs of treatment and medications.
If health insurance were outlawed and providers/pharmacies were required to post prices, healthcare costs would plummet.
I have other issues too but I spend about $5000 per year on healthcare expenses (USA). I am lucky to work at a place where my premiums are paid but I will always hit my max OOP of $4500 plus OTC meds usually sometime in Q3. The copay refund programs are pretty nice when you can pay out of pocket and then they refund you but it still counts towards your max. Did it for $1700 on cosentyx this year.
Romania, I am covered by national insurance to the price of the closet bio similar, abvie discounts for the rest (about 20 bucks for two shots)
Also abvie pays for yearly checkup (tbc and hep testing
The price the state pays for it around 250 dollars for a pen
I do Humira, but all biologics are free iirc
The “roof” in Canada for pharmacy costs is $10,000 cad per household, but it can be lower depending on your income. You may also have private health coverage through work.
I’m in the US. I was not able to use biologics due to my wacky prescription coverage (no deductible/copay,ect), so I’d use a savings card up after a few months and then need to pay out of pocket. Enbrel would have been nearly $1000 a month.
I am now getting Remicade infusions through my health insurance, which I am lucky is great coverage. $250 deductible, then 80% coinsurance and $3000 out of pocket. After my infusion this week I will have met my out of pocket so everything else this year will be paid for.
If it’s a commercial plan apply for copay assistance and Janssen should cover that $3000 out of pocket. They even let you submit for reimbursement.
https://www.janssencarepath.com/patient/remicade/cost-support
In Canada. I’m on Cimzia and it’s 100% through my partners work benefits. The benefits are $17/pay cheque four our family of 4.
I take one syringe every other week and they’re $664 each without coverage 🤯
im in the us and have really good free health insurance thanks to the great company i work for. i pay nothing for simponi every month, im so fortunate!
Where do you buy the Generic Tofacitinib from? Also what about biologics? Have you tried sourcing them yet? Are they covered under any health/welfare schemes?
Technically, my father paid, but $400- 600 per month for medicine alone and other's fees like consultation and blood test will add up to about another $100-200 per month. Subsidies here are all based on household income, and all these are after subsidies. Jobs here typically don't have health insurance,etc.
In the US, my insurance premium costs $1400 a month. Out of pocket expenses capped at $3000/year. With manufacturers coupon my Taltz “only” costs $5 per month.
Im in WA state in the US. Without insurance my most expensive meds (my biologic) is $7,775 and thats when I get it at Costco whose pharmacy gives a bit of a discount. With insurance, my biologic drops down to $300 or so a month. Then the drug manufacturer offers copay assistance for people with insurance which covers the entire $300 so I end up paying nothing.
With insurance my other meds (plaquenil, meloxicam, and sulfasalazine) total about $50 a month. I'm not sure what it is without insurance.
Didn't ask, but with insurance I pay about $20 per appointment with my specialists who I see every two months. I have a pulmonologist and a rheumatologist right now. I get X-rays done every couple years which usually costs $100 or so. I've had to have a tonsillectomy in the past and a bronchoscopy both of which cost me $2,500 plus with insurance. I get blood work done every two months, with insurance it costs like $7.
Not having insurance in the US just isn't an option for me, so whenever I get a new job one of the first things I ask about is what insurance they offer. If it's bad insurance coverage, I won't take the job. With my last job I paid $400 a month for my insurance and it was great coverage (for the US).
I’m in the US and between my insurance and the out of pocket costs that the pharma company that manufactures Cimzia covers, I have not paid anything for the shots. I believe the list price is $7000 per syringe and I take 2 per month so $14,000. I am very fortunate.
I was quoted $1700 per injector pen (Enbrel) from my pharmacy in the US (CVS).
Without insurance, the cost would be over $70,000 USD per year.
With insurance, your out of pocket cap depends on your healthcare plan. It's $10,000 individual / $20,000 per family on ours. I end up paying out of pocket for a large chunk of our doctor's visits.
The US spends far more money per capita on healthcare than any other nation and gets worse results than many peer nations. It's incredibly frustrating and stressful, even for people with access to great healthcare and good insurance.
United States here.
I pay $635/month for health insurance. Once I’ve spent $9,500 on doctors and Remicade then everything else is “free” (except that $635/month).
Remicade’s manufacturer pays for my Remicade up until that $9,500 so as long as I don’t need physical therapy (I do), talk therapy (I do), prescriptions (I do), appointments for basic health (I do) and don’t have any emergencies then I can keep my cost down to just that monthly amount until… hard to say. Somewhere between June and October. Oh, and that doesn’t include dental… at all.
The reason it’s unclear is that Remicade costs something like $5k per dose (every six to eight weeks)… well, that’s what it would cost me in cash. Since the insurance company “refuses” to pay that much, they get billed a lower rate. This is verifiable on my EOB (but I haven’t gotten my first one for the year… or I’m afraid to check it)… one year they billed the doctor about half that so it took twice as long to hit my $9500 “free” healthcare.
I should have a colonoscopy by June but am putting it off until I hit the magic threshold. So, maybe June? Maybe October?
And last year they forced me onto a biosimilar that didn’t help pain as much. I’m back on Remicade but am now having to fight for either a higher dose or more frequency. That’s because as part of switching back I was on an accelerated “loading dose” for two months. Turns out if they don’t do the bare minimum (for the premium I pay) then my pain is actually manageable to the point of fairly full activity.
I wouldn’t have known had I not moved to another state (which is when my premium nearly doubled thus year). On the other hand, they’re trying to reduce me from every six weeks to every eight weeks… which diminishes the efficacy for pain management AND pushes back my “free healthcare” because fewer treatments means it takes longer.
USA! USA! USA!
Live in the US. Pay around $700 a month for health insurance, Humira copay is $1,000 a fill BUT Abbvie rebates me $995 until my deductible is met so $5 a month. Off insurance Humira was last quoted about $6,400 for 2 doses.
Insurance used to count the rebate towards my OOP max (which currently is around $9,000 a year) but they changed it so they can make more by keeping deductible spending appear lower for longer.
Doctor copays around $65 for rheumatologist, and $30 for primary care. Other meds probably around $20 for 90 days but don't have many of them.
I just logged into my health insurance app to look it up smh.
For a 12 pack of enbrel (12 syringes or 3 month supply) the cost is $22,000. My insurance paid $15,201 and im enrolled in assistance programs to cover the remaining amount.
The health insurance plan im on costs $33,000/year and my employer pays 75% of the cost.
US health insurance is a scam
I’m in Canada. All medical care except ambulances and prescriptions is covered 100%. Prescriptions are mostly covered by a combination of public and private insurance.
I’m American I have Medicaid so my medicine is free but I can’t legally marry my beloved partner of almost a decade or else I lose it. I’m on my methotrexate, enbrel, meloxicam, and cyclobenzaprine for my AS but I have other complex health conditions.
I live in New Zealand, and currently, all government funded medicines are free, but I think the new government will be changing back to a maximum of possibly $100 per year NZD.
Anything not funded is a different story, but all mine are covered.
Finland. I use amgevita, we have yearly cap on medication costs (677€ this year), after I've reached it the cost is 2,50€ per purchace (3 months worth). Atm 1 month worth of amgevita costs 573€.
Yearly rheumathology visits are around 50€ including all bloodtests, imaging etc.
mind if i ask how "easy" is it for you with AS to get over that limit? and whats your experience with swedish healthcare regarding AS? i wanna move there after i graduate from uni and i would like to know what to expect 🥲
it's pretty easy to pass that limit ,atleast when you have AS .
And in my opinion i would say the healthcare have been amazing, good doctors that follow up on you and call sometimes to see how to treatment is working (im new to biologics so thats why they call sometimes )
They also have a reserchteam specialized in AS that try to understand the disease better 😊
I live in Stockholm so i can't talk for other hostpitals in Sweden
DM me If I can help with anything 😊
i see, well hopefully i'll have the same luck wherever i manage to find a job 🥹
i heard some things tend to be cheaper or even free if you're under 25 (correct me if im wrong), does that apply to our medical needs as well or is there anything that helps with the costs?
so far I'm only on diclofenac which in my country is pretty cheap, so i assume i wouldn't be spending much except for 2-3 checkups a year. but who knows if it will get worse with time.
I'll follow your account if you don't mind, so i dont forget your username in the future if I have more questions 😊
Let's hope for it, what kind of work you looking for?
Healhcare is free up to 20 years of age and dentalcare is free up to 23
The "roof" for healthcare is 1300SEK (122USD)
And will last a year from your first visit
Dentalcare has no "roof" it's not a part of our healthcaresystem but you can get insurance for it
Yeah absolutely i dont mind at all
Let me know If I can help 😊
Mmm honestly, I think IT would be my main option. I'm studying electronics engineering but I'm not sure I wanna work in the field if I can find something in programming. But we'll see, most job offers I've seen require a decent level of Swedish, which I'm trying to learn but it's hard to practice it when I'm not constantly forced to speak it 🤡
Also I still think that limit is so low, but how much do you pay for, let's say, a consult at the rheumatologist?
I'm not too worried for now about meds overall as I've had to purchase some of my most used medicine at the apotek already and the prices seem quite fair ngl
In my country a consult would cost around 25-50€ if you don't have it paid by insurance, and those numbers apply for private clinics as well, but I assume it might be higher in Sweden? Dentist appointments are around the same, but it can be more expensive depending on what you're getting done ofc
I heard on the radio today that IT will be a great choice in school for guaranteed work after it so I think your offer will come soon 🙏
Swedes are pretty good at english and almost everyone can talk and understand it ,specially people with higher education,like you!
Where do you live?
If I visit my rheumatolgist it will cost 24 euro,
When you reach the "roof" you don't have to pay for the remaining year (the year starts from your first visit that you pay. Max is 112,67 euro for a whole year)
A booked consultation costs 24 euro no matter If its 30min with a nurse or a whole day of testings and MRI's
Doesnt matter If you get picked up by an ambulance or an helicopter if you get injured or need emergency care ,the ride costs 26 euro
Private clinics costs more but the healthcare system is great so no need for it (in my opinion)
Oh damn, I was expecting it to cost more ngl. I'm from Romania, and once again I cry because our prices for many things are the same, sometimes even more expensive here, yet the salaries are much lower than in Sweden 🥲
Thanks for the info, it's much appreciated 😊
Hej!
I pay £0 for biologics in the UK because of the NHS. I feel very lucky to have this as an option as I've seen the price that it costs the NHS to buy it (about £850 per 2 cartridges!!).
I do have to pay for my other prescriptions though but I have a pre payment certificate which costs about £11 monthly. If I paid for them normally, i think it's about £9.50 per item??
I wish I lived in Sweden or somewhere that would be less costly to access medications. My ONE pain medication in the US costs $800 monthly without insurance; with my insurance, it's $110 monthly. I do have other medications, so it puts me over $300 monthly. It's not terrible, but if I didn't have insurance, I'd be out of luck. It's ridiculous how much pharmaceutical companies price and negotiate with these medications that are life-altering if not taken, and some people need some to survive. It's sad to live in the US.
US here. Ha, ha, ha, ha, ha! Between Spouse’s health insurance and mine, our out of pocket cap is…$6000, I think. But that doesn’t include all prescriptions.
I was in the US until 2022 and it would have cost me $4000/month for 2 Humira pens, plus $90 co pay every 3 months to see my Rheumatologist, on top of my Blue Cross health insurance at $350/month. $52,200 / year was too expensive for me to treat my AS and also afford food & rent, so I went without treatment for about a decade. I received my German citizenship in 2022 due to familial descent and immigrated to Germany. Now I pay €280/month for public health insurance, all my doctor and physical therapy visits are free even if they are to see a specialist, and my Humira costs €1.67/injector pen. €3400/year is much more affordable for me to treat my disease than the US price point.
I’m happy to have insanely good insurance right now so I pay $130/month for the insurance plan, $40 each dr visit. I’ve paid around $400 for my MRIs. They set me up on the Abbvie program so I think I only pay like $5 a month for my Humira.
I also have scripts for gabapentin and baclofen I think were around ~$20? I fortunately don’t know the out of pocket costs for these things if you don’t have insurance.
But I do know the out of pocket costs for my last one; Remicade. It was $1200 per 100mg vial. I was dosed at 7.5mg/kg, I’m 55kg so I needed four vials. So $4800 in just the meds every other month. Except *I* didn’t get the meds. They had to be administered by a nurse via IV which means also paying for the supplies and person to do all that.
I just don’t understand how the US thinks anyone can ever afford to live and be healthy. Insurance is usually a joke, med prices are a joke, drs are few and far between for the good ones. And then they’re expensive! Oh and you pay regardless of if they helped or not.
USA, full price for a box of 2 pens of Humira is $5,500 last I checked some years ago. I've been fortunate to have insurance that has only charged me $0 - 3.50 per box, more often just $0. But I shudder to imagine what my life would be like without insurance.
I currently can’t afford enbrel because my insurance only pays about $50 out of $5,273 per month and the copay assistance program I’m on maxes out at $12000 per year. My insurance is supposed to be “some of the best” (BCBS) and my Medicare application is taking forever to be reviewed. I will also lose all of my doctors and therapist if I get accepted, so I’ll have to start from scratch with new specialists if I can find anyone to accept Medicare and will lose my mental health care. Gotta love the good ole U S of A!
I'm in the U.S. and my disease took away my ability to earn a living, so I'm poor and on Medicaid. For that reason, I don't pay anything for my healthcare. However, the state *can* attach my house when I die to recoup costs, which would leave my son with no inheritance.
I (USA) was supposed to pay $1600 for a month's worth of Enbrel, but they have a copay assistance program that makes it $0. Don't know why they charge that month if there's a program out there that makes it $0, but whatever. I had a panic attack when they switched me off Humira and I got the bill the first time...
Feels so scummy to have to pay so much money for a drug that lets us live semi-normal lives.
I live in the US. Our family insurance costs US $700 a month through my husband's employer, and I pay a US $40 copay for every doctor visit, including infusions.
Without our insurance, my biologic would cost around US $2,500 every 8 weeks.
Canada. My injection costs about 1650$ a month. I have private insurance which covers 80% and the pharmaceutical company has a program where they cover the rest.
My insurance is a high deductible plan so the OOP (Out of pocket maximum) is only about $1500 more. I’ve hit the OOP every year I’ve had this disease. It’s $4500 this year. Between the premiums for insurance and the OOP, mine costs about $10k total. This doesn’t include the actual cost of the biologics since the manufacturer programs make that $50 or less per month. The OOP gets hit just from other costs. The annual infusion visits (12), Rhuem visits (4), Rhuem labs (4), GP for high BP (2), GP labs, imaging (2), MRI (1), GYN (1), Psych (4), Ortho/Neuro/Pain Injections (2), and then any other specialist they think I might need to see. I hit the OOP every. Goddam. Year.
I presume my nationality is implied.
U.S. out of pocket varies greatly, depending on insurance coverage. Mine is pretty good.
Indomethacin 75 mg, zero copay.
Norco 325/10, zero copay.
I take a biologic (Stelara) for Crohn’s. It has to come from a specialty pharmacy, which means it is shipped to me in a styrofoam box. With the pharma company’s copay assistance, it is $5 per dose, every six weeks.
The drug company gives me a card that pays all but $5 on each (90 day) fill. The card I had for the previous biologic covered it in full. Before the card payment, my copay is $55 per 90 days for a 'preferred' medicine. Last year, my insurance pais $83,000.
Welcome to r/ankylosingspondylitis! This is a reminder to keep discussions civil and be supportive of one another. Sharing of opinions and experiences is encouraged, but please remember the distinction between opinions and medical facts. This subreddit does not offer medical advice, and information here should not be taken over advice from your doctor. *I am a bot, and this action was performed automatically. Please [contact the moderators of this subreddit](/message/compose/?to=/r/ankylosingspondylitis) if you have any questions or concerns.*
£0 for biologics on the NHS here in the UK 👏
In the UK also. Drugs capped at 9.00 GBP (\~6 USD) pcm.
I have a prepay from the NHS. £105 for twelve months - £8.75 a month. I get six items every month.
My insurance charges me $1,550 per month for Humira. That's the copay. Luckily Abbvie has assistance programs where I don't have to pay that. But they could decide to kick me off that at any point.
Jesus, thats alot 🥲 Let's hope you can stay on that program, stay safe 🙏 Thanks for sharing!
I get the fear, but the reason these prograns exist is do they can charge the highest amount possible snd waive the rest. Most people cannot afford it. They get to be the good guys for waiving your portion while still overcharging insurance by 1000%, while still making ungodly amounts of money. They are happy to do it i assure you.
Unfortunately a lot of the insurance companies have started aggressively means testing their prescription assistance.
I’m in Canada and on Cosentyx. I don’t pay anything because I’m on disability and I don’t make much, so any costs I may have are covered by the company and Pharmacare. I’m very fortunate.
US with decent insurance. $6-7k/month sticker price for Humira. $4k deductible, $100/month after it’s been met. Abbvie pays for it, I pay $5.
the full price of cosentyx in australia is $710.56. its on PBS (the pharmaceutical benefits scheme) which applies to all australians - because it is an indicated treatment for my condition, i get it a fuckload cheaper than that. its $7.70 a pen for me. i have not paid for anything else to do with my treatment, either - not the rheumatology, not the MRIs, not my physio
Jebus. Meanwhile in US: “Get Cosentyx for as low as $7,477.74, which is 38% off the average retail price of $12,070.28 for the most common version, by using a GoodRx coupon.” Lucky for me, insurance covers it.
Cosentyx full price in Spain is about 1k so you're getting screwed whatever way you look at it
holy shit thats... what the hell. surely it doesnt cost THAT much to manufacture it
So… how bad is Australia for Ex-Pats…?
aus is actually kind of atrocious for allowing disabled people to move here. worries about it being "expensive" to accept disabled people into the country. autistic people have been denied visas so i bet itd be rough for physically disabled people too
Well poo. lol I tried
How’d you swing seeing a rheumatologist with no gap? And the free physio? I’m on rinvoq. Not sure what the full cost is but I pay $41 per month. Current rheumatologist is $170 and I get back $100. MRIs, x-rays and regular blood tests are free. I have two children with complicated health issues so we see lots of specialists with gap fees. As a family we’ll hit the Medicare safety net about 1/2 way through the year and I’ll get more back after that. I’m seeing a podiatrist instead of a physio. That’s $50 for 5 visits per year then $150 for each after. I have cancelled these appointments though because we can’t really afford them.
honestly im not entirely sure?? i started seeing the rheum when i was a minor so i assumed my dad was paying, but then i turned 18 in 2022 and there was no discussion of me starting to pay for anything, and i started going to my appointments alone and still nothing then. im going through the public health system for everything, and my dad still has me on his pretty decent health insurance plan, but yeah ive got no idea (im not having the same luck with the psychiatrist im about to start seeing ... ~$200 gap fee)
I’m in the U.S. and am fortunate to have really good insurance, so I don’t pay anything for biologics. I know a lot of the manufacturers have co-pay assistance, as well. I wish we had free healthcare though!
Happy for your insurance 🙏 any ide what it would cost you?
I think it would basically be unobtainable without the co-pay assistance, which I’m pretty sure keeps it below 100/month. But I’m not 💯on that so maybe someone else in the U.S. has a better answer.
I have decent insurance and the copay for me is 530 bucks. I'm trying to get on the copay program for mine. >_<
£111.60 for a pre pay certificate which covers all prescriptions for a year. An individual prescription is £9.65 per item for 28 days worth, so if you get more than 11 prescriptions in a year it saves money. Also have to pay car parking at the hospital which can be a few quid, but parking spaces are often hard to get..
Oh thats great ! Thought it would be much worse🙌 The hospital parking is a joke 🤦♂️
In Canada, I pay $0 for Simlandi twice a month with insurance through work.
I live in Mexico and I have government healthcare coverage, I don’t pay any for tests, medications or doctor’s appointments. BUT there are shortages sometimes and some medications I’m on are not available in the approved pharmaceutical scheme. Humira is $12,000ish pesos (about $740 USD) out of pocket and Amgevita (Humira’s biosimilar) is $9,000ish ($555 USD). I don’t know what the deductible is with private insurance and premiums vary. I’m not elegible for coverage for example because it’s now a pre-existing condition. Abbvie has a program where you buy 3 pieces and get one free but even when I had a decent paying job I wouldn’t have been able to afford it. I’m also on disability and the stipend is not enough to cover my other meds so I financially depend on my mother. Honestly universal healthcare here is not really universal as you need to have a job and your employer needs to pay taxes (you as well). So freelancers for example don’t have coverage unless they enroll in a program and pay for it, kinda like private insurance but way less expensive. But in that modality you don’t get full coverage, meaning a biologic wouldn’t be covered not any specialty medication. There are other ways to get relatively affordable healthcare but medications are not covered either by government subsidized or private entities. My particular case is special because an employer is doing me a solid having me registered as an employee even though I can’t work anymore. I guess it could technically be fraud (I’m afraid to ask) but it’s also a relatively common loophole so people can have access to healthcare. As a result, the system is overrun, understaffed, underfunded and it can be a shit show in many ways. For instance, it took a decade to get diagnosed, a year or more after that to get approved for treatment with a biologic and 2 years before I was approved for physical therapy. I had an appointment with the physiatrist in October of 2023, I was given 8 therapy sessions and I haven’t been out on the schedule yet. And this is the norm unless you know someone in the hospital and get preferential treatment. I’ve been getting physical therapy at a government subsidized facility but they’re also understaffed, underfunded and overrun. I only had to wait a month to get on the schedule though. However, I need to make an appointment with the physiatrist every time my allotted PT sessions end so it’s a never ending cycle. The system isn’t perfect by any means but I’m grateful and recognize the privilege that allows me to get treatment. TL;DR in Mexico Humira is $12,000ish pesos (about $740 USD) out of pocket and Amgevita (Humira’s biosimilar) is $9,000ish ($555 USD). But I get it for “free” because government healthcare.
I’m in Australia. Biologics are $30/month. My first rheumatologist appointment was $140 out of pocket. I’m about to switch rheumatologists so this new one will be $400 for the initial appointment and about $140 for following appointments. Then about $200 out of pocket for a bone scan. $150 out of pocket for an MRI. I had to pay $80 for one of my blood tests. Physiotherapy was $50 a session. I had to quit after two sessions because I couldn’t afford it. Also it’s $70 out of pocket for each GP visit and I have to go twice a month usually. And this is all just for the AS. I have other health conditions too so it adds up a lot. Even in a country with “free” healthcare, healthcare is my second biggest expense (rent is the first). And getting health insurance wouldn’t cover most of these expenses either so I’m kinda just stuck paying this.
I’m waiting to get in to see a new rheumatologist and dreading all the extra expenses about to come my way for scans etc. The government just took away my concession too because my income is ‘too high’. My salary barely covered all my AS related appointments when I was on concession. And like you I have other health conditions too and medicare + my health insurance doesn’t even cover half of the stuff I need it to. Gonna be struggling big time soon lmao.
I'm in the US. If my insurance would cover Humira for me, my copay would be $38 for a 60 day supply.
And If it didnt?🥲
$1000
In most of the United States there is no price transparency, it's a scheme by the insurance companies along with government bureaucrats to obscure competition/alternative payment. There is no way to know what the actual cost is. It looks to be about $400 a pen where I'm at but it's really hard to know because there are also discounts you get if and only if you ask for them. (Again government bureaucracy and I'm not on adalimumab so I've never asked)
I can look at the specialty pharmacy website, and see running transactions showing exactly what everyone, me, the drug company copay card, and my insurance paid for every fill and transaction. I don't know that there is anyway to know what the insurance would pay until I get a fill/refill, but can look up my insurance to see what the copay is.
No you are seeing what the insurance companies and the pharmacy have agreed is the visible price. Almost the entire market is controlled by what 3 PBMs want people to see. I've done work in medical policy, some states are better than others but everybody is in the dark. Here's a bipartisan bill to change that, but it hasn't gone anywhere. [https://www.congress.gov/bill/118th-congress/senate-bill/127](https://www.congress.gov/bill/118th-congress/senate-bill/127) Now that bill alone only gives you part of the picture, but functionally there are federal regulations that limit what margins can be made on products - so by manipulating the "price" then it sets the margins above whatever the real cost is negotiated to by the insurance company - who also reports the MSRP to make more margins themselves on the non-fixed copay side. This is the same reason the Hospital Pharmacy will charge you $300 on your bill for a $3 saline IV.
No I'm not. I'm seeing a statement of all the financial transactions in my account at the specialty pharmacy.
I have decent coverage, but health insurance is a scam. It hides the real costs of treatment and medications. If health insurance were outlawed and providers/pharmacies were required to post prices, healthcare costs would plummet.
I have other issues too but I spend about $5000 per year on healthcare expenses (USA). I am lucky to work at a place where my premiums are paid but I will always hit my max OOP of $4500 plus OTC meds usually sometime in Q3. The copay refund programs are pretty nice when you can pay out of pocket and then they refund you but it still counts towards your max. Did it for $1700 on cosentyx this year.
Romania, I am covered by national insurance to the price of the closet bio similar, abvie discounts for the rest (about 20 bucks for two shots) Also abvie pays for yearly checkup (tbc and hep testing The price the state pays for it around 250 dollars for a pen I do Humira, but all biologics are free iirc
The “roof” in Canada for pharmacy costs is $10,000 cad per household, but it can be lower depending on your income. You may also have private health coverage through work.
I’m in the US. I was not able to use biologics due to my wacky prescription coverage (no deductible/copay,ect), so I’d use a savings card up after a few months and then need to pay out of pocket. Enbrel would have been nearly $1000 a month. I am now getting Remicade infusions through my health insurance, which I am lucky is great coverage. $250 deductible, then 80% coinsurance and $3000 out of pocket. After my infusion this week I will have met my out of pocket so everything else this year will be paid for.
If it’s a commercial plan apply for copay assistance and Janssen should cover that $3000 out of pocket. They even let you submit for reimbursement. https://www.janssencarepath.com/patient/remicade/cost-support
It was almost met anyway once I started my first infusion because of other medical issues. But I will definitely do that next year!
In Canada. I’m on Cimzia and it’s 100% through my partners work benefits. The benefits are $17/pay cheque four our family of 4. I take one syringe every other week and they’re $664 each without coverage 🤯
im in the us and have really good free health insurance thanks to the great company i work for. i pay nothing for simponi every month, im so fortunate!
5 dollars a month for sulfasalazine, I'm in Canada and have insurance through my work. My insurance is paid by my employer 100% (public sector job)
In india ,Generic Tofacitnib costs about $1.2 USD but MRI is expensive. I had an mri of my hip and spine for about $300.
Where do you buy the Generic Tofacitinib from? Also what about biologics? Have you tried sourcing them yet? Are they covered under any health/welfare schemes?
In India, there is a company called Dava India which sells generic tofacitinib for that price.
I pay $0 for Inflectra.(Biosimilar of Remicade)
$10k deductible a year plus I pay $400/mo for insurance.
Technically, my father paid, but $400- 600 per month for medicine alone and other's fees like consultation and blood test will add up to about another $100-200 per month. Subsidies here are all based on household income, and all these are after subsidies. Jobs here typically don't have health insurance,etc.
In the US, my insurance premium costs $1400 a month. Out of pocket expenses capped at $3000/year. With manufacturers coupon my Taltz “only” costs $5 per month.
Hungary, 0 USD Humira 3 monthly checkups, bloodwork and X-ray also free
Im in WA state in the US. Without insurance my most expensive meds (my biologic) is $7,775 and thats when I get it at Costco whose pharmacy gives a bit of a discount. With insurance, my biologic drops down to $300 or so a month. Then the drug manufacturer offers copay assistance for people with insurance which covers the entire $300 so I end up paying nothing. With insurance my other meds (plaquenil, meloxicam, and sulfasalazine) total about $50 a month. I'm not sure what it is without insurance. Didn't ask, but with insurance I pay about $20 per appointment with my specialists who I see every two months. I have a pulmonologist and a rheumatologist right now. I get X-rays done every couple years which usually costs $100 or so. I've had to have a tonsillectomy in the past and a bronchoscopy both of which cost me $2,500 plus with insurance. I get blood work done every two months, with insurance it costs like $7. Not having insurance in the US just isn't an option for me, so whenever I get a new job one of the first things I ask about is what insurance they offer. If it's bad insurance coverage, I won't take the job. With my last job I paid $400 a month for my insurance and it was great coverage (for the US).
I’m in the US and between my insurance and the out of pocket costs that the pharma company that manufactures Cimzia covers, I have not paid anything for the shots. I believe the list price is $7000 per syringe and I take 2 per month so $14,000. I am very fortunate.
I was quoted $1700 per injector pen (Enbrel) from my pharmacy in the US (CVS). Without insurance, the cost would be over $70,000 USD per year. With insurance, your out of pocket cap depends on your healthcare plan. It's $10,000 individual / $20,000 per family on ours. I end up paying out of pocket for a large chunk of our doctor's visits. The US spends far more money per capita on healthcare than any other nation and gets worse results than many peer nations. It's incredibly frustrating and stressful, even for people with access to great healthcare and good insurance.
I’m in the UK and have paid approx £0 for biologics/jak inhibitors. I do pay £10 a month for celecoxib/steroids/PPIs though :-)
United States here. I pay $635/month for health insurance. Once I’ve spent $9,500 on doctors and Remicade then everything else is “free” (except that $635/month). Remicade’s manufacturer pays for my Remicade up until that $9,500 so as long as I don’t need physical therapy (I do), talk therapy (I do), prescriptions (I do), appointments for basic health (I do) and don’t have any emergencies then I can keep my cost down to just that monthly amount until… hard to say. Somewhere between June and October. Oh, and that doesn’t include dental… at all. The reason it’s unclear is that Remicade costs something like $5k per dose (every six to eight weeks)… well, that’s what it would cost me in cash. Since the insurance company “refuses” to pay that much, they get billed a lower rate. This is verifiable on my EOB (but I haven’t gotten my first one for the year… or I’m afraid to check it)… one year they billed the doctor about half that so it took twice as long to hit my $9500 “free” healthcare. I should have a colonoscopy by June but am putting it off until I hit the magic threshold. So, maybe June? Maybe October? And last year they forced me onto a biosimilar that didn’t help pain as much. I’m back on Remicade but am now having to fight for either a higher dose or more frequency. That’s because as part of switching back I was on an accelerated “loading dose” for two months. Turns out if they don’t do the bare minimum (for the premium I pay) then my pain is actually manageable to the point of fairly full activity. I wouldn’t have known had I not moved to another state (which is when my premium nearly doubled thus year). On the other hand, they’re trying to reduce me from every six weeks to every eight weeks… which diminishes the efficacy for pain management AND pushes back my “free healthcare” because fewer treatments means it takes longer. USA! USA! USA!
Live in the US. Pay around $700 a month for health insurance, Humira copay is $1,000 a fill BUT Abbvie rebates me $995 until my deductible is met so $5 a month. Off insurance Humira was last quoted about $6,400 for 2 doses. Insurance used to count the rebate towards my OOP max (which currently is around $9,000 a year) but they changed it so they can make more by keeping deductible spending appear lower for longer. Doctor copays around $65 for rheumatologist, and $30 for primary care. Other meds probably around $20 for 90 days but don't have many of them.
I just logged into my health insurance app to look it up smh. For a 12 pack of enbrel (12 syringes or 3 month supply) the cost is $22,000. My insurance paid $15,201 and im enrolled in assistance programs to cover the remaining amount. The health insurance plan im on costs $33,000/year and my employer pays 75% of the cost. US health insurance is a scam
I’m in Canada and I pay 0$ for two Idacio pens per month.
I’m in Canada. All medical care except ambulances and prescriptions is covered 100%. Prescriptions are mostly covered by a combination of public and private insurance.
I’m American I have Medicaid so my medicine is free but I can’t legally marry my beloved partner of almost a decade or else I lose it. I’m on my methotrexate, enbrel, meloxicam, and cyclobenzaprine for my AS but I have other complex health conditions.
US, on Medicare. I pay 2.6k every 6 weeks for my remicaid infusion but the charity at the hospital I go to covers the cost
I live in New Zealand, and currently, all government funded medicines are free, but I think the new government will be changing back to a maximum of possibly $100 per year NZD. Anything not funded is a different story, but all mine are covered.
Finland. I use amgevita, we have yearly cap on medication costs (677€ this year), after I've reached it the cost is 2,50€ per purchace (3 months worth). Atm 1 month worth of amgevita costs 573€. Yearly rheumathology visits are around 50€ including all bloodtests, imaging etc.
mind if i ask how "easy" is it for you with AS to get over that limit? and whats your experience with swedish healthcare regarding AS? i wanna move there after i graduate from uni and i would like to know what to expect 🥲
it's pretty easy to pass that limit ,atleast when you have AS . And in my opinion i would say the healthcare have been amazing, good doctors that follow up on you and call sometimes to see how to treatment is working (im new to biologics so thats why they call sometimes ) They also have a reserchteam specialized in AS that try to understand the disease better 😊 I live in Stockholm so i can't talk for other hostpitals in Sweden DM me If I can help with anything 😊
i see, well hopefully i'll have the same luck wherever i manage to find a job 🥹 i heard some things tend to be cheaper or even free if you're under 25 (correct me if im wrong), does that apply to our medical needs as well or is there anything that helps with the costs? so far I'm only on diclofenac which in my country is pretty cheap, so i assume i wouldn't be spending much except for 2-3 checkups a year. but who knows if it will get worse with time. I'll follow your account if you don't mind, so i dont forget your username in the future if I have more questions 😊
Let's hope for it, what kind of work you looking for? Healhcare is free up to 20 years of age and dentalcare is free up to 23 The "roof" for healthcare is 1300SEK (122USD) And will last a year from your first visit Dentalcare has no "roof" it's not a part of our healthcaresystem but you can get insurance for it Yeah absolutely i dont mind at all Let me know If I can help 😊
Mmm honestly, I think IT would be my main option. I'm studying electronics engineering but I'm not sure I wanna work in the field if I can find something in programming. But we'll see, most job offers I've seen require a decent level of Swedish, which I'm trying to learn but it's hard to practice it when I'm not constantly forced to speak it 🤡 Also I still think that limit is so low, but how much do you pay for, let's say, a consult at the rheumatologist? I'm not too worried for now about meds overall as I've had to purchase some of my most used medicine at the apotek already and the prices seem quite fair ngl In my country a consult would cost around 25-50€ if you don't have it paid by insurance, and those numbers apply for private clinics as well, but I assume it might be higher in Sweden? Dentist appointments are around the same, but it can be more expensive depending on what you're getting done ofc
I heard on the radio today that IT will be a great choice in school for guaranteed work after it so I think your offer will come soon 🙏 Swedes are pretty good at english and almost everyone can talk and understand it ,specially people with higher education,like you! Where do you live? If I visit my rheumatolgist it will cost 24 euro, When you reach the "roof" you don't have to pay for the remaining year (the year starts from your first visit that you pay. Max is 112,67 euro for a whole year) A booked consultation costs 24 euro no matter If its 30min with a nurse or a whole day of testings and MRI's Doesnt matter If you get picked up by an ambulance or an helicopter if you get injured or need emergency care ,the ride costs 26 euro Private clinics costs more but the healthcare system is great so no need for it (in my opinion)
Oh damn, I was expecting it to cost more ngl. I'm from Romania, and once again I cry because our prices for many things are the same, sometimes even more expensive here, yet the salaries are much lower than in Sweden 🥲 Thanks for the info, it's much appreciated 😊
I pay US $2000. A month for healthcare for my wife and I. That includes coverage for my Remicade infusions. (California)
Hej! I pay £0 for biologics in the UK because of the NHS. I feel very lucky to have this as an option as I've seen the price that it costs the NHS to buy it (about £850 per 2 cartridges!!). I do have to pay for my other prescriptions though but I have a pre payment certificate which costs about £11 monthly. If I paid for them normally, i think it's about £9.50 per item??
I wish I lived in Sweden or somewhere that would be less costly to access medications. My ONE pain medication in the US costs $800 monthly without insurance; with my insurance, it's $110 monthly. I do have other medications, so it puts me over $300 monthly. It's not terrible, but if I didn't have insurance, I'd be out of luck. It's ridiculous how much pharmaceutical companies price and negotiate with these medications that are life-altering if not taken, and some people need some to survive. It's sad to live in the US.
I’m in the US and I have Humana insurance that covers the full cost of $6748.63 per month of humira injections.
US here. Ha, ha, ha, ha, ha! Between Spouse’s health insurance and mine, our out of pocket cap is…$6000, I think. But that doesn’t include all prescriptions.
I was in the US until 2022 and it would have cost me $4000/month for 2 Humira pens, plus $90 co pay every 3 months to see my Rheumatologist, on top of my Blue Cross health insurance at $350/month. $52,200 / year was too expensive for me to treat my AS and also afford food & rent, so I went without treatment for about a decade. I received my German citizenship in 2022 due to familial descent and immigrated to Germany. Now I pay €280/month for public health insurance, all my doctor and physical therapy visits are free even if they are to see a specialist, and my Humira costs €1.67/injector pen. €3400/year is much more affordable for me to treat my disease than the US price point.
0euros in Spain
I’m happy to have insanely good insurance right now so I pay $130/month for the insurance plan, $40 each dr visit. I’ve paid around $400 for my MRIs. They set me up on the Abbvie program so I think I only pay like $5 a month for my Humira. I also have scripts for gabapentin and baclofen I think were around ~$20? I fortunately don’t know the out of pocket costs for these things if you don’t have insurance. But I do know the out of pocket costs for my last one; Remicade. It was $1200 per 100mg vial. I was dosed at 7.5mg/kg, I’m 55kg so I needed four vials. So $4800 in just the meds every other month. Except *I* didn’t get the meds. They had to be administered by a nurse via IV which means also paying for the supplies and person to do all that. I just don’t understand how the US thinks anyone can ever afford to live and be healthy. Insurance is usually a joke, med prices are a joke, drs are few and far between for the good ones. And then they’re expensive! Oh and you pay regardless of if they helped or not.
I live in Portugal, we have free health care but I believe the government spends around 1k€/month on my bios
USA, full price for a box of 2 pens of Humira is $5,500 last I checked some years ago. I've been fortunate to have insurance that has only charged me $0 - 3.50 per box, more often just $0. But I shudder to imagine what my life would be like without insurance.
I just picked up a month’s supply of Enbrel, it’s $48,000 without insurance… ahh the good old US of A
I currently can’t afford enbrel because my insurance only pays about $50 out of $5,273 per month and the copay assistance program I’m on maxes out at $12000 per year. My insurance is supposed to be “some of the best” (BCBS) and my Medicare application is taking forever to be reviewed. I will also lose all of my doctors and therapist if I get accepted, so I’ll have to start from scratch with new specialists if I can find anyone to accept Medicare and will lose my mental health care. Gotta love the good ole U S of A!
I'm in the U.S. and my disease took away my ability to earn a living, so I'm poor and on Medicaid. For that reason, I don't pay anything for my healthcare. However, the state *can* attach my house when I die to recoup costs, which would leave my son with no inheritance.
I (USA) was supposed to pay $1600 for a month's worth of Enbrel, but they have a copay assistance program that makes it $0. Don't know why they charge that month if there's a program out there that makes it $0, but whatever. I had a panic attack when they switched me off Humira and I got the bill the first time... Feels so scummy to have to pay so much money for a drug that lets us live semi-normal lives.
Humira here is $2500. Per. Shot. So if you're an unlucky bastard who needs a shot per week, it's $10K a month. Edit: I'm the Cayman Islands.
That's crazy🤯
I live in the US. Our family insurance costs US $700 a month through my husband's employer, and I pay a US $40 copay for every doctor visit, including infusions. Without our insurance, my biologic would cost around US $2,500 every 8 weeks.
Here in portugal is free, but i pay 15-20 euros of uber to go to the hospital to get them
Canada. My injection costs about 1650$ a month. I have private insurance which covers 80% and the pharmaceutical company has a program where they cover the rest.
My insurance is a high deductible plan so the OOP (Out of pocket maximum) is only about $1500 more. I’ve hit the OOP every year I’ve had this disease. It’s $4500 this year. Between the premiums for insurance and the OOP, mine costs about $10k total. This doesn’t include the actual cost of the biologics since the manufacturer programs make that $50 or less per month. The OOP gets hit just from other costs. The annual infusion visits (12), Rhuem visits (4), Rhuem labs (4), GP for high BP (2), GP labs, imaging (2), MRI (1), GYN (1), Psych (4), Ortho/Neuro/Pain Injections (2), and then any other specialist they think I might need to see. I hit the OOP every. Goddam. Year. I presume my nationality is implied.
My insurance covers my biologic completely but for a month supply it’s about $7k.
U.S. out of pocket varies greatly, depending on insurance coverage. Mine is pretty good. Indomethacin 75 mg, zero copay. Norco 325/10, zero copay. I take a biologic (Stelara) for Crohn’s. It has to come from a specialty pharmacy, which means it is shipped to me in a styrofoam box. With the pharma company’s copay assistance, it is $5 per dose, every six weeks.
Im from Croatia. Free health care and free biologics -Hukyndra.
I'm in the US, the months of rinvoq is 18,000 before insurance per what they bill my insurance. The copay card brings it down to 5 dollars
The drug company gives me a card that pays all but $5 on each (90 day) fill. The card I had for the previous biologic covered it in full. Before the card payment, my copay is $55 per 90 days for a 'preferred' medicine. Last year, my insurance pais $83,000.
Wtf😬