In last week’s post on open enrollment, I mentioned how I had gamed the health care system to my advantage. I promised to impart how I did that to you. This is that post, so buckle up, buckaroo!
It’s not a huge secret, but I went years without knowing this trick, and it would have saved me a lot of moola if I had known it sooner. I don’t want this to be a secret. I hate the thought of just one more person getting screwed by their medical expenses. All while pharmaceutical and insurance companies fill their pockets. I want you to have every advantage I didn’t. That’s why I’m writing this post. That’s why I’m writing this blog.
Right out of college, I was struggling to afford life. Between my student loans and medical bills, I was fucking strapped for cash. I struggled for about a year until one fateful day. I was bitching to an infusion nurse about how much the crap she was pumping into my veins cost when she asked if I had ever heard of the RemiStart program. I had not. The nurse explained that Janssen Biotech, the company behind Remicade, had a patient rebate program to help patients like myself pay for the cost of their outrageously priced drug. She had a folder of literature and everything! I don’t think it’s hyperbolic to say this conversation changed my life.
I’m sure you have questions, so let’s start with…
What’s a patient rebate program?
Patient rebate programs are the genius inventions of big pharma. They know their drugs are too expensive for most people to afford. Instead of changing the drug price, they pay for the cost of the drug, except for $5. You might be thinking to yourself, that’s really nice of them, but why the hell would they do that for me?
You’re right to be skeptical. They’re nice, but not that nice. You can only be part of one of these programs if you are covered by commercial health insurance. That’s because the pharmaceutical companies know that their drugs’ cost will quickly eat through a patient’s deductible and out of pocket maximum (remember those?). Once they help the patient reach their out-of-pocket maximum, the insurance company is stuck footing the bill for the rest of the year.
It’s a massive win for pharmaceutical companies. Initially paying for you to stay on the medicine allows them to make more than they would if you decided not to take the drug due to costs. You just so happen to reap some benefits as well.
How YOU can also save thousands
I’m sure it’s starting to become clear how I was able to save thousands of dollars in healthcare costs, but just in case it’s not, let’s go through step by step how this works.
Step 1
First things first, you’ll need to enroll in the rebate program associated with your medication. You may need to get a doctor’s signature, so give yourself plenty of time to get the application filled out correctly. If you’re not sure if the medication you’ve been prescribed has a rebate program, Google will be your friend. However, being the nice guy that I am, I did some googling for you. Here are a few common IBD medications that have patient rebate programs:
Humira: humira.com/humira-complete
Remicade & Stelara: janssencarepath.com
Entyvio: entyvio.com/copay-support
Pro tip: Ask your doctor or infusion nurse if they can help you get enrolled. I did it myself, and that forced me to keep track of a lot of paperwork. The process is much more streamlined if the doctor’s office takes care of it.
Step 2
Once you’re enrolled in the program, you’ll get a card that looks like a credit card. This is what you’ll use to pay for your medical costs. You’ll have to call to activate the card, and then you’re ready to start saving boatloads of cash.
Step 3
Now it’s time to take advantage of the program. I’ve found that there’s an easy way and a hard way to get your claims processed. I’ve only worked with Janssen Carepath, so I can only walk you through how that works. I’d assume the process is similar for other programs, but hey, I’ve been wrong before. Let’s start with the hard way.
After you receive your medication, whether it be an infusion or injectable, you’ll get a bill. You then take that bill and the explanation of benefits (EOB) from your insurance company and send that to the rebate program. When I first started using the program, I had to fax or email the documents. Janssen has since set up a web portal where all these documents can be uploaded. It’s important to remember that either the bill or EOB needs to explicitly say the name of the drug; otherwise, you’ll get your claim rejected. Trust me, I’ve learned this the hard way.
The rebate program will review the paperwork. If everything is satisfactory, they’ll load the cost of the drug minus $5 onto the card you were given. It’s important to note that this program will only pay for the drug’s cost, not the cost of administering it (for example, nurse or facility fees). You can then use the card to pay whoever sent you the bill. Fun!
Somewhere along the line, I found out there is an easier way to do this. Like I said in the pro tip above, you can let whoever administers your medication know that you have this card. They can then take care of sending all the paperwork to the rebate program, and you’ll get a neat little $5 bill in the mail. However, you might be dealing with incompetent or mean spirited people who don’t want to help. In that case, you’ll need to do things the hard way.
Don’t forget!
It’s important to remember this rebate program will cover your health insurance deductible. That said, make sure you don’t schedule any appointments or procedures until after you receive your medication. Why pay your deductible when you could have the pharmaceutical company pay for it instead? Now, don’t be stupid, don’t forgo essential medical care, but your annual checkup can wait a few months.
For many years, the game I ran was to not schedule any appointments or procedures for the first quarter of every year. I would get my monthly Remicade infusions, and Janssen Biotech would pay my deductible and coinsurance until my out of pocket maximum was reached. I could then see any in-network provider, and it would be covered at 100%! The way the math worked out, for many years, I would only pay around $250 per year (plus my monthly premiums) for my healthcare.
So there. Now you know my secret. Go forth and prosper!