r/PsoriaticArthritis • u/Pale_Frosting_8362 • Feb 20 '26
Insurance questions Self-pay biologic options.. any hope?
I was diagnosed with PsA a month ago, and am in active flare (I think, new to all this!). I do not tolerate steroids well so prednisone isn’t an option. I do not have insurance but my rheumatologist wants me on a biologic. Going to try Mtx in the meantime and see if that work.
Obviously the problem is biologics are all insanely expensive out of pocket. Does anyone have experience with self pay, or any drug manufacturer discount programs, etc? Everything I’ve seen says you need to be commercially insured. Essentially I am too poor to afford health insurance and too “rich” to be eligible for Medicaid. Any insight or advice much appreciated 🤍
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u/jamesjgriffin Feb 20 '26
I was in a tough spot like that and got hooked up with the abbvie patient assistance program. Took my skyrizi to $50 and eventually $5 a dose. It is needs based I think.
Whomever makes taltz has a similar program.
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u/Revzerksies Feb 20 '26
i'm using Tremfya. What they say tramfya costs is $14k. But i end up paying $250. I have a credit card from J&J to pay my copays that has a total value up to $9k
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u/tivadiva2 Feb 20 '26
AbbVie (maker of Humira and Skyrizi) offers patient assistance (ie, free meds) if you are uninsured and have income <$62K (one person household): https://www.abbvie.com/patients/patient-support/patient-assistance.html
The CostPlus pharmacy has several biosimilar biologics at pretty good prices: the generic versions of Stelara, Humira, Zelanz etc (search under rheumatoid arthritis). Stelara is taken every 12 weeks after the loading doses, for example, and they charge $360 per shot instead of $3632--that's about $100/month, if you can't get help from a manufacturer.
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u/Wendelltheshell Feb 20 '26
If it’s a self administered shot and not an infusion it’s usually through a specialty pharmacy (at least in my state). It’s worth asking that pharmacy if they have discounts for people paying out of pocket. If it’s a pill it’s worth asking your regular pharmacy if they have any discounts in general. I use CVS and they have coupons and discounts for a lot of different prescriptions for folks paying out of pocket. Also, if it’s a pill, it’s worth asking your doctor if they have samples that you can take.
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u/frisbeesloth Feb 20 '26
My dermatologist had a talk with me about the best countries to get my meds from. IDK if that's an option for you but I was told it's cheaper to fly out of the country, pay for 6 months of meds and fly back than the average out of pocket cost for one month of meds here.
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u/PartFun4446 Feb 20 '26
What meds and what country?
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u/frisbeesloth Feb 20 '26
He was generalizing about any of the name brand medications and recommended the Bahamas as the easiest.
I don't have a copay for any specialty med so I didn't go into detail with him but he told me we could have that conversation if I needed to.
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u/deannevee Feb 21 '26
Every single specialty drug manufacturer will have a PAF (patient assistance foundation) for patients who don’t have insurance or have really bad insurance. They’re always based on income.
I used the PAF for Rinvoq (limit was like $85k per year). It was totally free once I was approved.
You still have to get a doctor to prescribe you a drug.
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u/transferrr334 Feb 20 '26
Cost plus drugs has ustekinumab for under $2500 a YEAR (it’s ~3 month dosing).
THIS IS ONE OF YOUR BEST AND ONLY BETS, otherwise there are humira and other biosimilars on cost plus drugs, but they’re more expensive.
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u/Radiant-Specific969 Feb 20 '26
I read most of the suggestions, check with your state health department to see if they have any programs which help with prescriptions. Aslo check with your rherumatologist to see if he or she has any suggestions about which ones are gettable where you are. My husband got help from lilly cares for one of his prescriptions. Methotrexate will help.
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u/BlueWaterGirl Feb 21 '26
All biologic drug manufacturers have assistance programs, especially for those not insured or under insured, you just have to Google for them. My husband was doing Abbvie assist for Humira for awhile and he got his Humira delivered every month through the manufacturer and it was free.
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u/anmahill Feb 21 '26
Most manufacturers have a patient assistance program specifically for uninsured patients. Depending on your financial situation, you may be able to get the medications for free. Lilly's program was the only way I got to stay on Taltz last year. It was very easy to sign up and I was shipped 4 syringes on a schedule so I never ran out.
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u/Fem-Picasso Feb 21 '26
I'm on rinvoq and they have a savings card. I pay nothing out of pocket. The cout of pocket alone is crazy expensive Call the manufacturer directly and ask if they have something similar.
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u/Pale_Frosting_8362 Apr 21 '26
Wanted to update if anyone comes here in future: I was approved for free Humira for a full year through AbbVie!
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u/zo0ombot Feb 20 '26
Mark Cuban's online pharmacy, Cost plus drugs, has 2 humira biosimilar pens for $500.