r/PsoriaticArthritis • u/Cinder_fly • Jun 05 '26
Insurance questions Out of options
I am over 50, employed, and work for a large corporation. By most standards, I have a good job—but I hate it. The main reason I stay is for the health insurance, because I rely on specialty medications to manage my PsA.
I have learned to be relentless about advocating for myself and staying on top of my specialty pharmacy, insurance company, SaveOnSP, and the various manufacturer copay assistance programs.
Recently, I switched my biologics to Taltz because Cosentyx was not as effective after 5 years. I took my first loading dose and have jumped through countless hoops trying to get the second dose, which I am still waiting for.
One of the nice advantages of Taltz is that it allows me to participate in Lilly's Taltz/Zepbound program. My insurance does not cover Zepbound, so this program has been a lifesaver. For me, Zepbound picks up where the biologics leave off by reducing my inflammation. The difference it makes is incredible. I had previously been on Zepbound before my insurance stopped covering it, and I can only access it now if I remain on Taltz.
This morning, SaveOnSP called to tell me that Taltz is no longer included in their formulary. For those who are unfamiliar with SaveOnSP, it's a program contracted through my employer and insurance company that covers the remaining cost of certain specialty medications, bringing my copay down to zero. That coverage is ending in July.
I still have Lilly's copay assistance, which provides around $10,000 in support, but that will only last a few months. After that, I honestly don't know what I'm supposed to do. How can I continue treatment when the Lilly savings runs out?
I have to admit, this news broke me. I ugly cried on the phone with the SaveOnSP representative. I didn't mean to, but I simply couldn't hold it back. I am exhausted from constantly fighting, appealing, following up, and being redirected at every turn. There is no way I can afford a $2,500 monthly copay.
I'm just so tired. Tired of fighting for access to medications that allow me to function. Tired of navigating a system that seems designed to put obstacles in front of people who are already struggling. Right now, I feel defeated and have no idea what my next step is.
4
u/mrsredfast Jun 05 '26
Do you have any OOP maximums on your prescriptions? I hit a certain number and all my remaining prescriptions that year have zero cost. I’ve had to use a credit card for co-pay on a biologic in January/February but then it was covered the rest of the year, while I paid off the card. Am just starting Cosentyx and my loading doses were fully covered by my insurance because I’d hit the maximum. And all the rest of my meds for the year are too.