Medication costs in United States

[Karen Endelman]

I have good insurance so I don’t pay much. I’m taking Opsumit which is listed at $12,000 for 30 days! I can’t even imagine who they think could pay that!

People here without insurance then you’d be using the Medicaid system. First, since I don’t really know how that works, you’d have to check and see if you’re qualified to be on Medicaid. If you are, then you’d have to see how much of the cost of those specific drugs will cost you.

Medical care is not cheap here in the US. So, please make sure you know what your medications and doctor visits will cost before making any decisions.

Good luck with whatever you decide.

[Shawn]

Alright thank you so much for the reply. I’ve been trying to research this and it’s proving difficult I almost wish I could just visit and have a talk with someone at a PH hospital.

My meds are roughly half of yours combined and I’m assuming that’s because I’m in Canada getting “free” healthcare which often translates nowadays to bottom of the barrel treatment, or get what get type stuff. I was wondering if you could give me a rough idea of what you pay out of pocket after your insurance? I’m in a union so if I made a transfer I imagine I’d have health insurance and I reckon it would be decent.

[Elena Rich]

Hi,

Your cost & expenses will really depend on your insurance. There is often some funding available on name brand drugs through the manufacturers and some grants available that will help cover copays on generics. The problem is that a lot of name brand meds are not covered in some private insurance plans (provided through your job) and then there is the scramble to get prior authorizations and having your doctor go to bat for you with the insurance company to get something covered. Co pays on specialty meds can be very expensive, even with good insurance.

I work for a big company with pretty good insurance and it is always a very stressful exercise to get my medication at the beginning of the year. I am on IV Remodulin which I receive weekly so getting all of my new insurance information and getting the proper approvals is a challenge. I hit my deductible & maximum out of pocket every year right at the beginning of the year so you will need to budget for the expenses that you may not have with your current coverage. That can be thousands of dollars a year, that you’ll need to pay. For example, my deductible is $1500 and my maximum out of pocket is something like $3000 which is $4500 out of pocket each year PLUS what I pay in premiums out of my paycheck. If I don’t have the $4500, I have to finance that amount.

You will also need to consider how you will handle the transition between Canadian insurance and when your insurance in the US would start. If you have a gap in coverage you’ll need to have a plan for that because being without your meds and care is not an option.

Healthcare is a huge challenge in the US. Our system is very broken and if you are chronically ill and you have to work for your insurance (which can be very costly), the loss of your job and insurance puts you in a position of possibly having to live in poverty to maintain insurance. It is a scary position to be in, our insurance is tied to a job that we may not be able to maintain if and when our disease progresses.

[V.R. Peterson]

Shawn, here in America, people are usually either self-pay or they have insurance that usually requires copays.

I looked up both Adcirca and Tadalafil on Good Rx, a discount prescription service that doesn’t require a membership. Both medications are the same thing. Adcirca is the brand name, and Tadalafil is the generic for the same drug. By using Good Rx to buy the generic, depending on where you live, it could cost from $25-$34 a month, depending on the dosage and the city where you’ll be buying the medication. Below, you’ll find the link for the search I used.

https://www.goodrx.com/adcirca?form=tablet&dosage=20mg&defaultQuantity=60&manufacturer=BRAND

Doctor visits in the United States are quite expensive, as are hospital visits and tests. However, some doctors and hospitals offer a discount for self-pay patients. If, before moving to America, you could line up a job that has health insurance as part of their benefits package, that would help your situation greatly.

Pulmonary Hypertension Association has a section that offers charitable financial help for those who are in need. You may be able to find help from one of the non-profit organizations that help those in need. The link for financial help is: https://phassociation.org/help

On the above PHA page, you can also find contact information for the pharmaceutical companies that manufacture medications, as well as financial help for non-medical purposes, as well.

[Lynda]

Hello There,

All the previous information you see here is really good I personally take Tadalafil, Nifedipine which both you can get on Good Rx cheap I however also am on Opsumit that is almost $12,000 a month that without insurance and a savings card from the maker of the drug would not be able to afford here and would probably get from India for approx $800 for 7 months. I also am on a clinical trail that we have available here in the United States. I hope everyone’s feed back helps you to make an informed decision!

Make it a great day!

[jen-cueva]

Hi @Shawn, you’ve had some excellent information on healthcare here in the States. It will be very different from Canada. I have a few PHriends in Canada and they share their opinions on healthcare there, too.

I am on my hubby’s insurance and I use a copay assistance card for one of my PH medications. The other is approximately $200 per month. Plus, the other medications I am on for side effects, symptoms, and other health conditions.

I saw that @V.R. Peterson shared some links that I thought of sharing, too. Hopefully, this will offer you the information needed to base your decision. Have you always lived in Canada, or was this a short-term home?

If you know the area you plan to relocate to, maybe you can find a PH Center there and email or call them. You can use the PHA-Find a Doc link below to locate PH specialists.

https://phassociation.org/patients/doctorswhotreatph/

How have things been going for you? How are you feeling about your current PH treatments? Please do keep us posted.

phassociation.org

Doctors Who Treat PH

DOCTORS WHO TREAT PULMONARY HYPERTENSION PHA provides the following lists of physicians who treat PH as a service to patients and does not specifically endorse any individual physician. All information has been provided by the doctors so that you can … Continue reading

[Shawn]

Thank you for your response sorry I was really busy this week and forgot to get back to everyone here so I’m slowly doing that. I’m going to have to start searching for ph Centers that was a good suggestion, and yes I’ve always lived in Canada. I’m doing really well I suppose , I’m a plumber doing new builds my day to day is not very challenging although I can’t jog anymore or run I get by pretty good otherwise.

sometimes I’m concerned that I was misdiagnosed, I don’t exactly trust our health care here in Canada they don’t want to spend a lot of money, but who knows I just noticed I seem to be doing exceptionally well compared to other PH patients, I am grateful.

[jen-cueva]

Hi @Shawn, no worries. It sounds like plumbing is keeping you busy. You mention you think you could be misdiagnosed with PH because you “are doing exceptionally well” compared to others. But remember that there are such variances within the PH community. It could also be that they caught it early.

However, once you are in the States at a PH center, they will most likely perform their tests. A right heart cath (RHC) and Echocardiogram. These tests would offer you more answers.

Which areas in the states are you looking at? If it were me, I would look at the map of PH specialists, find areas you’re interested in, and see how many PH specialists are available nearby.

@elena made an excellent point; you may need some coverage between the move and beginning new insurance here. That can be costly. When do you think this move would happen? You could probably qualify for state-assisted healthcare in the time in between. Do you plan to work as a plumber here, too?

I hope you plan and will also have support wherever you move. The love and support from family and friends make a world of difference. Please continue to keep us posted.