Paying for specialty medication

I recently had to go on a specialty medication that has to be processed through my prescription insurance’s “specialty pharmacy” (mail order only). The first two days the prescription sat at my local Stop & Shop pharmacy waiting for pre-authorization from the specialty pharmacy that my doctor had to call in. After an hour on the phone we were advised that the medication was pre-authorized but couldnt be filled by my local pharmacy. Or any other pharmacy for that matter, they were blocking so Im stuck paying their price and cant shop around?? Another day for my doctor to fax over a new prescription to the “specialty pharmacy”, they have to then process it through my prescription insurance to see if its covered, its not because of my deductable. My order is then canceled and re-processed through the “specialty pharmacy” at over $1,400 for a one month’s supply, which is just a single shot. I spoke with the medication assistance department (at the same company) and they said I qualified for a deduction of $125. (mind you they never even asked for any personal information: income, etc). Fast forward two weeks, medication is (finally) mailed, shot is done and I have an invoice sitting here less the discounted price. I was expecting to have to pay over the phone before they mailed it out. I’m really not looking forward to getting back on the phone with them to sort this out. Their was so much disconnect and miscommunication with this company that I’m just whipped. Their must be other options for this medication because unfortunately I may need a refill in a few weeks and my health insurance is useless.

Thanks for your ear.

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Wow. There is a lot of evil floating around drugs and pharma sometimes. And I worked in the field.

This takes a real effort. What does your doctor recommend? I would also call the insurance company and work with them. The drug company itself has programs for people who can’t afford their medicines. How do people on your job deal with this?

I would also contact the local association ie lung association if you have lung problems. They are always advocating for their people. I would also find a community blog or Facebook group of some kind. For my job we have a national blog for people who do my work. I am a cluttered so there is a group for that too.

I live in a bigger city so there is a group for universal healthcare. They hear all the horror stories and might know some tricks. You can also call the pharmacy at a local hospital and ask questions - and also call the nurses at the hospital departments. They might tell you something. And call the darn newspaper! This is a community moral crime!

You can also look for clinical trials at They have treatments for free. I signed up for a few free yearly treatments for weight loss.

Call around to all the pharmacies. They might have different prices. Plus can you get the drugs from Canada? I don’t know the rules for that.

I wish you luck. I have Asthma and do contract work so sometimes have to pay a lot for an inhaler. Inhalers are so common and I just don’t understand why they would be so much money.


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Hello, I’m very sorry you’re having to deal with the frustration of it all. I used to work for a specialty pharmacy, which is a pharmacy authorized, through different channels, to handle specialty medications.

I recommend you contact the specialty pharmacy directly yourself. Ask to speak to someone in the co-pay assistance department. They are knowledgeable about different assistance programs through drug companies as well as foundations that provide assistance. Tell them straight out that You cannot afford the medication even at the reduced price. At that point you will probably be asked for financial information to qualify but I can tell you from experience, I’ve seen drugs costing up to $30,000 per month, reduced to less than $10 through this type of assistance.

A few other things to consider is contacting the drug manufacturer directly for assistance. Search the internet for information about the drug and a foundation that would help you. Simply search co-pay assistance for _______ (insert name of drug here.

Also check to see if your condition has an organization for patients. An example would be the heart association or diabetes association or the kidney association. Those organizations are often able to point you in the right direction if they can’t help you directly.

And never, ever be afraid to ask to speak with a supervisor. Please also know, those of us who worked for specialty pharmacies really want to help.

I sincerely hope that some of this will help you.


I have been on Xolair for allergic asthma for several years and the Manufacturer, Genentec, has been providing it to my doctor FREE!

My Dr. is changing me to Fasnera made by AstraZeneca, and they, too have authorized providing the medicine to my Doctor’s office for free!

For both applications, which were done by phone, I was asked several questions regarding age/family size/income, etc., so it sounds as if your medicine’s manufacturer might not be among those who provide any real discount! And, frankly, that sucks!

If your income is low enough, you would be able to receive funds from Medicaid. My only other suggestion would be to contact the Group from whom you receive medical care and ask if they have an aid program of some sort. Mine does and I lowers all of my in-network medical bills by about 90%!!!

Good luck to you. I’ve been there and understand the frustration AND the scary bills!