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Re: Ortiz post# 333455

Thursday, 10/21/2021 2:53:19 PM

Thursday, October 21, 2021 2:53:19 PM

Post# of 518751
A biologic that my sister takes costs about $13,000 per injector. The company that manufacturers the biologic put her into their savings program (all you need in order to qualify is proof that you have insurance coverage), which pays the first $30,000 in costs. When the manufacturer bills her insurance company, the cost of the injector is repriced in accordance with their contract (which in her case is about $5,000 per injector). Once the $30,000 savings plan is exhausted, my sister must pay out of pocket until her maximum out of pocket limit is reached (which in her case is $3,500). Once that happens, then her insurance plan covers 100% of the cost of the biologic for the remainder of the year. Therefore, in her case, the annual cost of her biologic is $156,000, but she only pays a maximum of $3,500 per year. This is an example of how such expensive medications are paid and how families can afford it...

The question is who is going to pay for it and how.

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