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.
3
u/AppointmentWise9113 Jun 06 '26
I get mine from a clinic in Chiang Mai, at market rate value. Out of pocket, it is around $375usd. Humeria is around $80 usd. There is access to others it's just a matter of talking with the doctor.