Family and Caregiver Schizophrenia Discussion Forum

Financial ideas - Invega Sustenna urgent

My boyfriend has been in Invega Sustenna for over a year now and it works amazing for him. This is the first thing that has ever worked for him and controlled his symptoms. Johnson and. Johnson has provided assistance for him in the past to where he pays very little for his shot. Now suddenly with no change in insurance they have denied him saying he has to use his health insurance benefits which is 1700 a month. We can’t afford anywhere close to that. Now we don’t know what to do but we are about to drop his insurance so he will have no health insurance just so he can get the financial assistance from Johnson and Johnson which is really scary but we don’t know what else to do. Does anyone know if anything else we can do first? We are at a loss but he is going to be in a very bad place without this medication. If we have to drop it health insurance than we will that is how strongly we believe in this medication but that is scary as well. Thank you for any thoughts or suggestions. I know this is a long shot because not many people may utilize this medication.

I’m sorry I don’t quite understand your explanation of how he has been currently getting his shot paid for.

  1. “Johnson and. Johnson has provided assistance for him in the past to where he pays very little for his shot.”

Johnson and Johnson has provided what current assistance and under what program?

  1. “Now suddenly with no change in insurance they have denied him saying he has to use his health insurance benefits which is 1700 a month”

What insurance plan/program are you referring to that has denied him payment for his monthly shot? Is it currently insurance through Medicaid, Obamacare/Marketplace, or private insurance that you’ve purchased yourself or have through a employer plan? Is he on a Medicaid plan that gives him a monthly allotted dollar value to use?

  1. Now we don’t know what to do but we are about to drop his insurance so he will have no health insurance just so he can get the financial assistance from Johnson and Johnson which is really scary but we don’t know what else to do."

I am only aware of Johnson and Johnson offering ONE YEAR of help if you apply and qualify due to low income.

What about the pill form of the medication? It has a generic. It’s not as expensive.

Oh I didn’t realize that was only one year. The odd thing is that they took his paperwork and then denied him because he has coverage with the 1700 deductible for the shot. I would have thought they would have said that was only a one year program. I am new to this and it’s very confusing. I am just trying to find a way to help. It was Johnson and Johnson patient financial assistance. He currently has Health Alliance through the marketplace.

We will have to look into the generic pill form. I think he’s scared bc the shot has worked and he doesn’t have to worry about forgetting it. He is not good with remembering but we are going to have to make that work. I will look into the generic version name and go from there since there doesn’t seem to be other options.

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Is your health insurance deductible $1,700 per year? If there is no way you can gather this money (with most plans, I’m not sure about those on the market place, after you meet the annual deductible all other covered medical expenses for the year are paid by insurance subject to any co-pays that remain up to the maximum out of pocket expenses.) While scary to change what is working well at present, he could try the pills. It is still the same medication. There are probably posts elsewhere on this Forum (you can search) about how to qualify for Medicaid.

His deductible with health alliance makes it so he has to pay 1700 per shot for 6 shots and then they will help pay the rest of the year but we do not have that kind of money in anyway. Yes and I looked up the generic for it so we will have to look into switching. It is very scary to switch for him because he knows this works but it is the same thing and I don’t think there will be an issue of him not taking it we just have to have a game plan because he forgets his other meds sometimes but knowing how important this is I don’t think it’ll be an issue. He knows the importance of it. Thank you very much. Scary as it maybe there are options that are feasible. I wish these drug companies wouldn’t make this stuff so inaccessible. Here’s out brand new drug and it’s awesome but no one can afford it. Thanks again this gives me a lot of hope!!

That IS a lot of money. You are fortunate that he recognizes the need to take an AP. You are absolutely right, a game plan will be important! You have the right ideas to get through this!

If your pharmacy is connected with a hospital or medical complex, you might be able to apply for patient financial assistance. We have this with a hospital and we have actually been able to get many prescriptions at no cost at their pharmacies. My daughter did get her first dose of haldol for free, but I do not know what to expect when we have to refill.

Medicaid covers the cost of the shot for my son. $1700 isn’t too bad if it’s annually.