Discussions

Hi all. I am facing the fact i may have to start a drug Entyvio. Cost is $3400 a month! My insurance would cover%70 leaves me $1000 a month.Even if i can convince Pharmacare to cover this drug my deductible is $7800.  
Here is my question.Ive been told that the drug total COST($3400) is what goes towards my deductible,not the $1000 i pay out of pocket. Wondering if this is correct.If this is the case then i would only have to pay $1000 a month for 3 months and not $1000 a month for 8 months! I hope this question isnt confusing.I really appreciate any info from you folks.

the pharmacist where you get your medication.  
I assume the doctor has applied for EDS for your new med?

With Pharmacare, you pay the total cost of your pres:cription meds UNTIL you deductible has been reached. Then Pharmacare pays for it all.

The total goes towards your deductible, not your copayment.  
Check drug the manufacturers website, sometimes they have programs that essentially take care of any copayment you have until pharmacare kicks in…this will essentially make it no-cost to you. Good luck!

It's the total amount that counts towards your deductible. Years ago, our daughter had to take a medication that was $1900 per 5 day supply. We hit our deductible in a few weeks.  
 
We had insurance at the time that covered 80%, but they only covered it if we proved we applied for pharmacare.  
 
Make sure your doc does the paperwork for exceptional drug status if that applies, or else it won't count towards your deductible.  
 
Edited by Abbysmum, 2021-10-16 12:45:38

Also be sure it is the specialist who has applied for EDS. This is one of the medications that EDS must be applied for by a gastroenterologist, not a primary care provider (MD or NP).

So from what I understand from your folks and put is that it is not the amount that I actually pay for the drug that goes towards my pharmacare deductible. It is what the drug total cost would be without my insurance that goes towards the deductible? So the drug retail cost is $3,400 a month and even though I'm not paying that amount it is the $3,400 a month that goes towards my pharmacare deductible ? If I understand your responses right. This is a huge relief.