In addition to featuring personal stories of individuals and their families who are impacted by dilated cardiomyopathy on this blog, we will also share helpful tips or suggestions related to DCM. This blog post was written by Greg Hershberger, a DCM patient and the Treasurer of the DCM Foundation Board of Directors. Greg shares what he has learned about paying for ENTRESTO®, which is one of the medications he takes for DCM .
The information that I am providing in this blog is of my own personal experience. (*Please see medical disclaimer below.)
A couple of years ago, I was prescribed ENTRESTO®, a heart failure medication, to help treat my dilated cardiomyopathy. Without doubt, this medication has proven beneficial in improving my heart health and overall health. The cost is very expensive, even with good insurance.
I applied online for an ENTRESTO co-pay card which reduced my co-pay from $250 to $10 per month. There is a calendar year limit of $2400 which can be used for prescriptions. The way they figure this is by taking what your co-pay would be without the card, forgiving all but $10 per month, up to a total of $2400 per calendar year.
Well, I reached the $2400 limit in ten months, as my co-pay without the card is about $250 per month. Then I had to shell out about $500 for the remaining two months before the $2400 allowance kicked in again on January 1. So my monthly refills with the ENTRESTO co-pay card amounted to about $600 ($10 x 10 months = $100 + $500 for last 2 months = $600).
My insurance also has a mail order option, so I checked into it. ENTRESTO is covered and I could get a three-month supply with a $125 co-pay, which is a little less than the monthly refills for the entire year. But better yet, Novartis (the ENTRESTO pharmaceutical company) will reimburse my out of pocket costs except for $10 for each refill. So I switched to mail order, after my doctor approved, and now pay $40 per year co-pay for mail order instead of $600 per year for monthly supply.
Every insurance plan is different, and even options within the same plan can differ on what they pay, what the co-pays are, and so forth. But it helped me to check out my options, and in the process saved me money.
I hope you can do the same!
*Medical Disclaimer: All DCM patients are different. Information presented on the DCM Foundation website is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Please consult your physician, cardiologist, or other qualified health providers with any questions you may have regarding a medical condition and/or before doing any activity.