Is a Tier 5 Specialty Exception possible?

[wehotex]

I have an Aetna MAPD PPO mb who was prescribed Ofev, a T5 specialty that was approved for her pretty quickly.
The price however is about $2,000/mo (initially at least). The drug does not appear to be at a discount according to needymeds.org and she does not qualify for LIS.
I think that a T5 exception is a big ask, but has anyone ever seen a T5 price lowered to a T4 price?

 

[DS4]

but has anyone ever seen a T5 price lowered to a T4 price?

Never, ever, ever.

 

[kgmom219]

Nope, but I would still tell them to call

I would also have them get with the prescribing doc and ask about infusion/covered under Part B options

 

[wehotex]

Nope, but I would still tell them to call

I would also have them get with the prescribing doc and ask about infusion/covered under Part B options

Thanks. The Infusion was a no-go. She was given 2 assistance companies which take financial information from her. She was also given info about a Foundation who told her that there were NO FUNDS available and put on a waiting list. This just sucks.

 

[DS4]

The price however is about $2,000/mo (initially at least).

Is this the price running through the PD?

 

[wehotex]

Is this the price running through the PD?

Im just going by what she wrote on Facebook. I tried to call her earlier, but she was drowning her sorrow at a bar. I need to clarify with her. She said $2,700, which (I would hope) is the negotiated cost? I have another mb who takes OFEV, but she’s LIS , level 1. Night and day comparisons. Being broke azz pays off.

 

[DS4]

$2700 is a drop in the bucket toward the cost. Without financial help, the first Rx would put you in the Catastrophic level.