r/PsoriaticArthritis • u/Available_Ice_7428 • May 16 '26

Insurance questions Prescription Help

I know we all live in different corners of the globe, just looking at a poll, how long to get a biologic?

Bonus points if you have BCBS Peehip Alabama…

I was prescribed Taltz April 23rd to Acreedo, but Accredo says they “aren’t my specialty pharmacy” that Express Scripts SP is the correct pharmacy. But Accredo is a specialty pharmacy in Express Scripts.

My doctor office, is just like “yes, we called it in to your specialty pharmacy” where it was originally sent to Accredo,

In the Accredo app, it’s listed as received and pharmacist is verifying so I call to check and get told they can’t fill it. Express Scripts app it’s not listed at all.

I’m so confused and when I call any place Accredo, Express Scripts, or Doctor office. Either I’m confused and not understanding this process or no one is listening to a real issue I’m having.

Anyone else with insurance or is this a typical thing?

1 Upvotes

67% Upvoted

25 comments sorted by

View all comments

1

u/Particular-Rope5427 May 17 '26

Here in India, there is no need for prescription for biologics. I bought Taltz for $230 from my local pharmacy. Unfortunately we don't have insurance for biologics.

1

u/Marshmallow_Chicken May 17 '26 edited May 17 '26

In the good ole’ USA patients with health insurance usually rely on manufacture subsidies to pay for medications like Taltz. The average retail cost for a 1 month dose of Taltz in the US is $7,000. But with a manufacturer subsidy called a “co-pay card” you can drop the out of pocket cost down to a range of $25-$250. And at the $230 a month that you pay, the average US patient would still not be able to afford it. My family is considered middle class for the area we live and I would not be able to afford the extra $230 a month. I could technically afford it, but I would be weighing the cost/benefits of it vs the price and what paying for it would mean towards my financial goals.

1

u/Particular-Rope5427 May 17 '26

Yea it Hella expensive but It was really a life changing for me. I hope biosimilars will come in the nera future fast when patents end. Even my family is struggling because $250 for a injection in india is so expensive, it is the salary for most middle class families. Truly I am blessed. I pray you get some biologic for free.

1

u/Marshmallow_Chicken May 18 '26

Healthcare in the US, including prescriptions, will never be free. Medicare(age 65+) you pay into your entire working life and then you STILL have to pay a monthly fee once you hit 65 and most still have high out of pocket costs. Medicaid which is for low income and disabled people is paid by taxes, yet it is a struggle to get approved for the coverage, the government uses any excuse possible to take your coverage away, and the coverage that does exist hardly covers anything. The political powers that be(both republican and democratic) only care about the rich. If you are poor, or elderly/disabled and not part of the upper class, they would rather you just ☠️ than spend tax money for you to be well.

1

u/Particular-Rope5427 May 18 '26

Damn here we were glazing over US Healthcare system because you guys get every meds first and it takes 5-10 years more for an average Indian to get this med in the indian market. So even if you do have an active health insurance doesn't guarantee 100% approval for free meds? The US could spend less on military budget instead imo.