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The newest plot twist is that I got a phone call this morning from someone who said she was calling from the specialty pharmacy, that the copay was the same large amount they told me yesterday, and would I be interested in assistance paying that? When I said yes, it turned out the process from there is that she sends a message to someone, who will look into it and get back to me. (Last year, the drug company was covering my much smaller copays, but that program explicitly excludes Medicare.)
When I mentioned the call to Cattitude, he suggested I check to make sure it's legit. The drug company's website had nothing relevant. I then tried calling the pharmacy and got nothing useful, so I opened another online chat. The agent confirmed that this is a real thing, with the disadvantage that it can take a while. She said they have a team whose job is to look for foundation or other grants that might help, and then help me apply if they find anything. I'm on that team's list of patients to try to find help for, but there's a queue.
The current plan is that the delivery has been rescheduled for Saturday, and if I don't hear from them by Friday I'll postpone it a few more days. I'm not sure how long I should leave this for, and I may call the MS nurse and ask how long it's reasonable to wait for the next dose. (I think the most recent dose was Dec. 13th, because that was my last reminder in Google calendar, so I've got a couple of weeks, maybe more.)
I had been thinking that Kesimpta costs enough that I will definitely hit the annual out-of-pocket maximum, and that it doesn't matter much whether I hit that number in February or later in the year, but this might keep my total prescription drug costs for the year below the cap.
Pasting in part of the conversation with the chat agent:
I do show the account was referred to our Reimbursement Counseling Center. To better explain, our Reimbursement Counseling Center is a team here at CVS Specialty that is dedicated to finding additional assistance for patients who are not eligible for other government funded programs.
Live agent - 11:33:07
CVS Specialty
Keep in mind, this team does require a significant amount of time in order to obtain any assistance from grants or foundations and there is a possibility that the patient may not qualify for any assistance either.
Live agent - 11:33:12
CVS Specialty
There is not a time frame that we can provide you with, as this team works all referrals in the order that they were received.
Live agent - 11:33:16
CVS Specialty
As soon as any updates may be available to you, a Reimbursement Counseling Center representative will be giving you a call to go over any details.
No, this is an internal team with CVS that looks for copay assistance options that may be available.
They typically source the information and pass along the contact info for you to enroll in the program.
When I mentioned the call to Cattitude, he suggested I check to make sure it's legit. The drug company's website had nothing relevant. I then tried calling the pharmacy and got nothing useful, so I opened another online chat. The agent confirmed that this is a real thing, with the disadvantage that it can take a while. She said they have a team whose job is to look for foundation or other grants that might help, and then help me apply if they find anything. I'm on that team's list of patients to try to find help for, but there's a queue.
The current plan is that the delivery has been rescheduled for Saturday, and if I don't hear from them by Friday I'll postpone it a few more days. I'm not sure how long I should leave this for, and I may call the MS nurse and ask how long it's reasonable to wait for the next dose. (I think the most recent dose was Dec. 13th, because that was my last reminder in Google calendar, so I've got a couple of weeks, maybe more.)
I had been thinking that Kesimpta costs enough that I will definitely hit the annual out-of-pocket maximum, and that it doesn't matter much whether I hit that number in February or later in the year, but this might keep my total prescription drug costs for the year below the cap.
Pasting in part of the conversation with the chat agent:
I do show the account was referred to our Reimbursement Counseling Center. To better explain, our Reimbursement Counseling Center is a team here at CVS Specialty that is dedicated to finding additional assistance for patients who are not eligible for other government funded programs.
Live agent - 11:33:07
CVS Specialty
Keep in mind, this team does require a significant amount of time in order to obtain any assistance from grants or foundations and there is a possibility that the patient may not qualify for any assistance either.
Live agent - 11:33:12
CVS Specialty
There is not a time frame that we can provide you with, as this team works all referrals in the order that they were received.
Live agent - 11:33:16
CVS Specialty
As soon as any updates may be available to you, a Reimbursement Counseling Center representative will be giving you a call to go over any details.
No, this is an internal team with CVS that looks for copay assistance options that may be available.
They typically source the information and pass along the contact info for you to enroll in the program.
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