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Discussion Starter · #1 ·
Hello all, I would welcome any experience or advice others have.

After many years of suffering, my wife found relief in Lotronex last year. We both have the same insurance available from our employers. Last year, we were able to fill it as a regular script for approximately $180 per month. This year both of our employers switched this to Medco and Express Scripts and will only allow it to be filled through this. We are being told our portion of the co-pay for a month supply is $2500.00 with the remaining ~$66,000 being paid by insurance. Per month! We struggled with the extra $180 per month in our budget, but $2500 is impossible.

I'm hoping there is a solution or something I'm missing due to lack of knowledge on the subject. However, we have received no solutions from the doctor, pharmicist, or Medco. The only suggestion made was to try a Canadian Pharmacy, but we have been unable to find one due to import regulations.

Has anyone else ran into this issue? Neither of us can really change our employeers at this point.

Thank you in advance for any advice or information.
 

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I don't think Lotronex is available in Canada, I don't think it was ever approved.

That price just doesn't sound right as most of the on-line pharmacy prices are just under $1000 a month, are they sure they are looking at the right drug?

I might call the manufacturer as most of them have a patient assistance program and tell them you can't afford it if the insurance company insists the medication is much more expensive the pretty much any other medication on the planet as most specialty cancer meds run like $66,000 a YEAR not a month.

If they really have jacked the price to $66,000 a month I might call the FDA and see if there is anyway to complain about that, it shouldn't go up from $1000 a month to that price all of a sudden. That doesn't seem right.

I suspect someone at Medco picked the wrong medication when quoting the price, but if you have called a couple of times and that really is what it is I dunno. Why they would charge that much when you can buy it out of pocket at pretty much any pharmacy on the price checker I looked at for under $1000 a month??? just because you HAVE insurance???

If that really is the only price you can get and you can't possibly get on an assistance program see if Zofran (or it's generic) or Ramosetron will work and if they are charging the same outrageous prices for those.

If you check their online pricing thingy here https://host1.medcohealth.com/medco/consumer/homearticle.jsp?pageid=JP_Medication_Pricing&lh=PriceAnRxJumpPage what does it say it should cost?
 

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I agree with Kathleen..... just doesn't sound right.
 

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Discussion Starter · #4 ·
Thanks for the response, Kathleen. When I don't log in to Medco and just check through the link you included, the price is much lower (~$800). Still pretty high, and out of our budget, but not nearly as bad as $2500.

I'm still trying to talk to someone at Prometheus to inquire about copay assistance, but so far nobody who answers seems to know anything about a program. They direct me to a savings card, which we were already told isn't eligible for use with our plan.

I will ask my wife, but I think she has tried the other drugs you mentioned without any success.

Thanks once again.
 

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Still the 800-1000 dollar range should be the without any insurance at all cost, so maybe they just aren't covering it at all.

I dunno what programs Prometheus has and that may be the only one, but if your insurance copay is the exact same as the retail price I'm surprised they still won't do anything at all for you.

I'd call Medco and ask if they are just not covering the medication at all anymore since their copay listed is the same as the retail price.

You may also be able to get the doctor to write them a letter to get them to cover the medication. I did that for something when I had Medco.
 

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I do employee benefits and I've never heard of this medication costing so much. You need to talk to the HR/Benefits people at your work and see if they can get involved to help.

What kind of a medical plan do you have? PPO or HSA? If you have an HSA you need to see if the Rx benefit "caps out" or has a limit on it. Also, under "Obamacare (god I hate that word) many plans Rx copays will appy towards your out of pocket maximums in 2014 (2015 for some plans).
 

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I am a Lotronex volunteer Mentor, for gals thinking of or taking Lotronex after being on it for 6+ yrs.

I have Blue Cross insurance. Aetna prior. Same things happened with both:

Corner pharmacy prices are lots higher than their MAIL ORDER!

I now pay only $95 for 3 months supply of Lotronex =6 boxes. My dose is 2mg/day.

The mail order supplier told me 'cant do it' but I suspected the insurance did not wish to pay for their part of it. ANY insurance mail order supplier can get Lotronex immdeiately if they wish to.

So I called Lotronex =Prometheus Labs, at the ph number on their webiste ....... 1-888-423-5227 option 3. I told them the story of mail order said not ordering Lotronex. Prometheus called the mail order supply and 30 minutes later, Lotronex on it's way to me at $95. for 3 months supply!
 
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