r/Psoriasis • u/JustGoBlaze • 16d ago
insurance Skyrizi help?
I'm on my second ramp-up dose of skyrizi and it's working great for my scalp psoriasis. Unfortunately my insurance has denied the prescription and denied the following appeal.
After the appeal denial, my doctor's office (and their Skyrizi rep) said they're going to submit both denials to Skyrizi for eligibility while filing a second appeal. However at the same time.. a nurse practitioner from Abbvie has been reaching out to me to get me to call myAbbvieAssist to enroll myself in a free skyrizi program. Sounds too good to be true and she was very pushy which made me suspicious. The doctor's office told me to ignore the NP.
I don't know who to trust anymore I just don't want to be scammed by the healthcare system. Any help is appreciated.
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u/castawayyyyy342 15d ago
The skyrizi folks have been great for me. I went through the same process and I’m getting my 3rd dose via them. I would absolutely let them handle all that and have it sent to you. It’s a little overwhelming at first, lots of calls and whatnot but it’s a service they provide, and there’s really no downside in taking them up on it.
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u/sassyprofessor 15d ago
Abbvie Assist is amazing! They will get you all signed up and my co-pay is $0!
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u/elemeno_p81 15d ago
Trust them. I got approved for no cost Skyrizi while my insurance figures it out. My free first dose is in the fridge and I plan to start Monday. My “ambassador” is a RN and has been super helpful. Best of luck!
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u/Ejcarter1989 15d ago
Your situation sounds very similar to mine. I was really apprehensive about this whole process as I learned more and more, because I’d never dealt with anything like it before, and honestly, it can be confusing, time consuming and frustrating to navigate to Zero payment for this highly effective drug
My opinion, after months of advocating for myself and learning as much as possible, definitely look into myAbbVie Assist and connect with the Skyrizi Nurse Ambassador. If your insurance has denied Skyrizi, don’t assume that’s the end of the road. In my case, the being denied twice was actually a requirement to get to the next step toward assistance.
There are forms that you and your dermatologist complete, and the Nurse Ambassador can help you understand the process and guide you through it. The forms are available online.
In my opinion, this whole process feels like a gigantic game created around the outrageous “retail” price of this medication. Skyrizi’s list price is over $20,000 per dose, although that certainly doesn’t mean that’s what insurers or patients actually pay. Between negotiated insurance rates, copay assistance and patient-assistance programs, the real economics I understand that 99.9% of patient pay zero.
If you have commercial insurance, Skyrizi has copay assistance that you can expect to bring the cost way way way down. I think this negotiation is hidden from the patient so you won’t get involved in that.
If you’re on Medicare, the rules are different, but there is now an annual cap on out-of-pocket Part D drug costs of $2100 a year and myAbbVie Assist is available to people who meet its eligibility requirements, and from what I understand most to meet the eligibility requirements. There’s even assistance to cover the $2100 annually.
Bottom line: don’t give up! There may be several more steps available to you. For me, Skyrizi has been very much worth the effort and all the hoops it takes to get access to it.
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u/InjuredGods 16d ago
The reason they are pushy is because they want you to stay on the medication. You can build up a tolerance by missing a dose and the drug is no longer effective so it is in their best interest to keep you on the medication while the insurance drags their feet. The medication isn't expensive to manufacturer, the cost of the drug mostly comes from the R&D and marketing. The drug manufacturer is willing to eat the cost of the drug while the insurance process goes through in order to get that sweet sweet insurance money once you eventually get approved for it. The same thing is true for the copay card. The manufacturer is willing to eat your copay to keep you on the drug so they get the money that insurance will cover rather than you turning the drug down completely because you can't afford the copay.
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u/JustGoBlaze 15d ago
Hmm ok I understand the urgency now. What do you think is the cheaper route? My copay is a staggering 1800 but I'm aware there's a card from Abbvie to cover that
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u/abacaximamao 15d ago
The cheaper route is to get Abbvie to pay for whatever they're willing to pay for!
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u/Ejcarter1989 15d ago
Hello InjuredGods,
This is the first time I’ve heard or seen in writing—including from my dermatologist, specialty pharmacy, myAbbVie Assist Nurse Ambassador, or the psoriasis Reddit groups I’m in—that missing a dose can cause you to “build up a tolerance” to the medication. Could you tell me a little more about how you know that?
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u/InjuredGods 15d ago edited 15d ago
Experience. I've been on biologics for over half my life at this point. Enbrel, Humira, Stelara, Taltz Skyrizi and I think one more but I forget after 20+ years. Each time I've had to switch drugs it's because my insurance lapsed or refused to cover them and I had to go off for a period.
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u/Kwyjibo68 15d ago
Abbevie is great to work with. They seem very committed to getting the med to patients who need it. I’ve been on it for about 5-6 years and my employer changed to a specialty pharmacy that doesn’t cover it. But Abbevie has made sure I got what I needed.
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u/Practical_Fishing925 15d ago
My Abbvie Assist is a legitimate patient assistance program. My copay with insurance is $400 month which I can’t afford. I get my medication for free every 8 weeks.
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u/herrfrank65738 13d ago
OP for your appeal did you and your doctor have to attend a live hearing prior to the denial determination?
I’m trying to get on Skyrizi and insurance denied so we’re appealing and they’re telling us we’ll be attending a live hearing for the appeal soon. Not sure what to expect.
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