Janumet, Invokana and Diabetic Discount Drama!


How I got Invokana
and Janumet for “Almost Free”

For those who are regular readers of my blog, I ask for your understanding.  Alas, this post will be DRAMA free!  Eeeeeekkkk!  Aaaaaiiiieeeeee!  Yes, I know, it is hard to believe that I can do a post with no drama… … well with a minimal amount of drama, but tis true.  🙂

So… about getting drugs for “almost free” …

It helps if you have insurance

Actually, it REALLY helps if you have insurance.ACA image 

If you are a low income individual without insurance; or if you are a small business owner who wants to see if you can get a better deal; or if you are just curious, then head on over to Healthcare.gov and get all the information on how to use the insurance exchanges and perhaps qualify for subsidies.

It may, depending on your circumstances be possible for you to sign up even though open enrollment has closed.

Also, it MIGHT also be possible for you to get your health insurance for FREE or for you to receive substantial subsidies from the Federal Government (US Residents only) to help you pay for your health insurance.
..
Speaking from a personal point of view, without the insurance that I get thanks to the Patient Protection and Affordable Care Act, my life would be in mortal danger.

No drama.

No kidding.

100% truth.

If you have insurance, the insurance should pay MOST of the cost of these drugs

Drug Formulary Yes and No

But every insurance policy is different; you need to check to be sure.

Using myself as an example: when I first tried to fill the prescription for these two drugs, I discovered that my copay for each drug, after the insurance was applied, was $100 (100 x 2 =$200 per month).

Eeeeeeeekkkk!! oh, oopps I said no drama.  My bad.  Moving on. 😉

To find out how much your copay is going to be before you go by the pharmacy, ou have to check something called a “drug formulary.

You can usually find the Drug Formulary in a PDF file or as a searchable database on your insurance company’s website.  Or you can call the customer service 800 # for your insurance company and ask for a paper copy be mailed to you.

Check the back of your

insurance card for the web address and/or the phone number.

Basically, each year, insurance companies and drug companies, who both like to make as much money off of sick people as possible, draw up these lists of “drugs” and break the list into levels or “tiers”  that work something like this:

  • –> Tier 1 — you pay zero – the insurance company pays 100%  Most generic drugs fit into this category.
  • –> Tier 2 — you pay a bit more, perhaps $10 or perhaps $20 depending on your insurance. The insurance company pays the rest, if the drug actually costs more than your $10 or $20 copay.
  • –> Tier 3 — you pay a LOT more — My “tier 3” copay is $50 or the negotiated price of the drug, whichever is lower and it is almost always $50
  • –> Tier 4 — you pay A HELL OF A LOT MORE! — My Tier 4 is $75 dollars.
  • –> Tier 5 — you pay  OBSCENELY MORE! — My Tier 5 is $100 dollars per month per drug!  That is where Janumet and Invokana fall under my insurance policy which is Blue Cross Blue Shield of Texas.  Eeeeeeekkkkkkk  AAaaaaaaaiiiiieeeeeee!!!! oh, oopps  — more drama.  I’m trying, I’m really trying.  My bad.  Moving on. 😉
  • –> Tier 6 — you pay the full retail price of the drug.  And the insurance company pays…. [all together now…] nothing!

For me, anything outside of Tier 1 or Tier 2 really is not possible to do.  I simply can not afford it.

Why? I’m glad you asked. 😉

pay-palI live on a pension of $812 per month plus about a $100 – $120 per month that I scrape up through various “odd jobs.” Obviously paying $200 a month was not possible.  That would be roughly 20% of my monthly income.  Yes, this is a bald faced plea for money… …if you have a spare $1 or $2 and you enjoy my blog, then hit that big “DONATE to Tony” button over to the right or just click this link)

Janumet & Invokana Discount Programs

Basic RGBSo I was faced with a choice.  Go back to my doctor along with a paper print out of the Drug Formulary and find another drug that would do the same thing or use a “discount program.”

Fortunately along with the prescriptions for Janumet and Invokana, my doctor ALSO gave me some brochures about two programs offered by the companies which make these two drugs. You can either ask your doctor for the brochures / cards or you use links that I have down below.

The great news is that I applied and was approved for the programs.  YAY!  The net result is that my out-of-pocket cost is now ZERO for Invokana and only $5 each month for Janumet. And, of course, I have to continue to pay my monthly insurance premium.

Each company has two programs (1) a 30 day “free trial” and (2) a twelve month “discount coupon” program which basically covers your copay up to $100 / $95 respectively

NOTE:  you may have to tell the clerk at the drug store to enter each coupon and each prescription as a separate “sale”  The clerk I had tried to put both drugs and all four “coupons” on the same sale.  Not until he separated things out did the coupons apply correctly.  The clerk had to ring up and apply the 30 day coupon for each drug individually and completely close out that sale before moving onto the next.  Then and only then, could they they enter the 12 month discount coupon toward the rest of the year.

Here are the links so that you can apply for the same programs that I got into:

A bit of commentary about the cost of Healthcare in the United States…

I’m going to turn the floor (ahem, the soap box) over to my Inner Domestic Diva.

My Inner Domestic Diva on a Soapbox ©And about that “no drama”  you can forget about it completely during the following discourse:

If I am understanding how this works, these two drug companies are basically agreeing to sell these drugs for the amount of money that the insurance company is willing to pay.  They are giving me a coupon that basically makes my cost zero for one and $5 for the other.

Correct me if I’m wrong, but doesn’t that mean that these drug companies could, if they choose, just make the price of these two drugs a $100 cheaper! For EVERYBODY! Not just the folks who find out about the discount program?

Sheesh! Face it, no company is EVER going to negotiate a price that is lower than what it costs to make the product.  So even at $100 dollars off their “normal retail price” they ARE STILL MAKING MONEY!!!

So, why aren’t the drugs “cheaper” for everyone instead of doing this weird coupon thing?  I don’t have an answer for that.

But I think it is a VERY good question

What my insurance pays according to the Drug Formulary

Here is what my insurance pays EACH MONTH for these two drugs, according to the drug formulary.  Built into that amount is the profit for the drug manufacturer and the pharmacy that dispenses the drugs:

  • InvokanaInvokana
    $352 Retail Price for a 30 day supply (30 tablets 1x per day)
    -$252 MINUS Amount paid by insurance (Blue Cross Blue Shield of Texas)
    ————–
    $100 << My copay amount
    -$100 MINUS  “discount coupon”
    $0 << My final cost
    ..
  • janumetJanumet
    $339 Retail Price for a 30 day supply (60 tablets 2x per day)
    -$239 MINUS Amount paid by insurance (Blue Cross Blue Shield of Texas)
    ————–
    $100 << My copay amount
    -$95 MINUS  “discount coupon”
    $5 << My final cost
    ..

Anyone who wonders why healthcare costs keep going up, only needs to look at figures like these.

See ya on the dance floor!

 

thanks for the info

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About TxCowboyDancer

Eight time Country Dance World Champion. I love to dance. In the middle of a journey, transforming myself from "unemployed and out-of-shape" to "in-shape and full time dance instructor, writer and graphic artist."

Posted on Mon, Jul 27, 2015, in Living with Diabetes and tagged , , , , , , , , , , , . Bookmark the permalink. Leave a comment.

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