Does anyone have experience using Ambetter insurance for their Tremphya prescription? I know I need pre-approval but want to see want an Ambetter user might have to say.

Sorry James I can't help with that as we don't have insurance in the UK, but I hope one of our American members can help you

Hi James! 

Sorry I don't know anything about Ambetter insurance.  I have been on biologics here in the States and basically your best bet is to check out the Tremfya website and see what programs they offer to help with coverage.  I have paid $0 to $20-25 for biologics.  Also, you can check and see if your doctor's office is willing to help you with that.  Mine actually took care of getting me in some of the programs offered by the different drug companies.  You should be eligible for one of the programs unless you get government insurance (Medicaid/Mediare) which changes things.  There are different options available to keep the cost down.  Also, you could contact Ambetter and ask them how much they would cover but my guess is that it won't be enough and you'll benefit from the company's program (Janssen who also makes Stelara which I was on and through their program I paid $0)

Good luck and Welcome!!

Kat

Ha James,

Hope that Kat has given enough tips.
From my side I can’t help you, in my country it is all differently organised.

Kat, isn’t Janssen, called Johnson & Johnson at your side of the ocean?
Janssen is basically a Belgian company who started to cooperate with Johnson & Johnson in order to be able to grow.

(Mon-23-01-2023, 01:53 AM)Kat Wrote: Hi James! 

Sorry I don't know anything about Ambetter insurance.  I have been on biologics here in the States and basically your best bet is to check out the Tremfya website and see what programs they offer to help with coverage.  I have paid $0 to $20-25 for biologics.  Also, you can check and see if your doctor's office is willing to help you with that.  Mine actually took care of getting me in some of the programs offered by the different drug companies.  You should be eligible for one of the programs unless you get government insurance (Medicaid/Mediare) which changes things.  There are different options available to keep the cost down.  Also, you could contact Ambetter and ask them how much they would cover but my guess is that it won't be enough and you'll benefit from the company's program (Janssen who also makes Stelara which I was on and through their program I paid $0)

Good luck and Welcome!!

Kat

Hi, James. 

Kat's spot on with advice.  I had Ambetter some time ago and had no trouble getting Humira after doctor's office sent in pre-authorization paperwork, but I also have help through AbbiVie and pay only $5.00 each month.

Good luck.  Let us know how it goes.  Welcome!  

(Mon-23-01-2023, 08:39 AM)Caroline Wrote: Ha James,

Hope that Kat has given enough tips.
From my side I can’t help you, in my country it is all differently organised.

Kat, isn’t Janssen, called Johnson & Johnson at your side of the ocean?
Janssen is basically a Belgian company who started to cooperate with Johnson & Johnson in order to be able to grow.

Johnson & Johnson bought out Janssen back in 1961. Some things are known under one name here, like the covid vaccine they made was commonly referred to as the Johnson & Johnson vaccine. Other things are referred to as made by Janssen but I'm not sure as to the why. The trademark for Janssen is listed as Janssen with smaller letters saying "pharmaceutical companies of Johnson & Johnson"

But yeah, they are the same company.

On the Tremfya website they have the following:

Tremfya and me (name of program)

Prescription and Cost Support

You’ll receive support to help you: verify your insurance coverage, understand how to fill your prescriptions, and look for options that could make your treatment more affordable.



I think it's much easier if the doctor's office helps get things set up, but if they don't then just check the website and go from there. You can most likely get assistance through the company program if you need help getting things set up. They should have a phone number or something where you can ask questions.

(Mon-23-01-2023, 16:09 PM)Kat Wrote:

(Mon-23-01-2023, 08:39 AM)Caroline Wrote: Ha James,

Hope that Kat has given enough tips.
From my side I can’t help you, in my country it is all differently organised.

Kat, isn’t Janssen, called Johnson & Johnson at your side of the ocean?
Janssen is basically a Belgian company who started to cooperate with Johnson & Johnson in order to be able to grow.

Johnson & Johnson bought out Janssen back in 1961.  Some things are known under one name here, like the covid vaccine they made was commonly referred to as the Johnson & Johnson vaccine.  Other things are referred to as made by Janssen but I'm not sure as to the why.  The trademark for Janssen is listed as Janssen with smaller letters saying "pharmaceutical companies of Johnson & Johnson"

But yeah, they are the same company.

In Belgium (and Netherlands) they still speak about Janssen. Close to me is the factory where they developed the Covid vaccine. In the logo Janssen is still very available.


Over here they called the vaccine the Janssen Vaccine…
As the vaccine should have given a lot of freedom, they had the sentence: “Dancing with Janssen”, which in Dutch…. “Dansen met Janssen” really sounds better.

(Mon-23-01-2023, 16:40 PM)Caroline Wrote:

(Mon-23-01-2023, 16:09 PM)Kat Wrote:

(Mon-23-01-2023, 08:39 AM)Caroline Wrote: Ha James,

Hope that Kat has given enough tips.
From my side I can’t help you, in my country it is all differently organised.

Kat, isn’t Janssen, called Johnson & Johnson at your side of the ocean?
Janssen is basically a Belgian company who started to cooperate with Johnson & Johnson in order to be able to grow.

Johnson & Johnson bought out Janssen back in 1961.  Some things are known under one name here, like the covid vaccine they made was commonly referred to as the Johnson & Johnson vaccine.  Other things are referred to as made by Janssen but I'm not sure as to the why.  The trademark for Janssen is listed as Janssen with smaller letters saying "pharmaceutical companies of Johnson & Johnson"

But yeah, they are the same company.

In Belgium (and Netherlands) they still speak about Janssen. Close to me is the factory where they developed the Covid vaccine. In the logo Janssen is still very available.


Over here they called the vaccine the Janssen Vaccine…
As the vaccine should have given a lot of freedom, they had the sentence: “Dancing with Janssen”, which in Dutch…. “Dansen met Janssen” really sounds better.

Yeah, Dancing with Johnson & Johnson doesn't have the same ring to it.    The Janssen/J&J vaccine is no longer available here due to some very rare side effects that caused blood clots I think it was. 

Well before Fred yells at us and tells us to get





@James - Since Forest had Ambetter Insurance and was able to get help from AbbVie (the manufacturer of Humira) it sounds like you shouldn't have a problem.    Most all offer their own type programs.  With Stelara (Janssen/Johnson and Johnson) I got my injections at an infusion center, not sure why.  With Cosentyx they had a savings card and I had to get my meds through a mail in pharmacy (they came in cold packs) which took a little bit of getting set up but my doctor's office handled most of it and the mail in pharmacy contacted me and handled the rest.  I don't remember on Taltz if it was a mail in pharmacy or if I picked them up.    I think it was through a mail in pharmacy as well.  So each company may handle it a bit differently but they each do offer assistance in keeping the cost down or even making it no cost to you. And I should add I don't think Stelara being at the infusion center had anything to do with the company. I may have appeared a bit unsure about self injecting at that time so they decided to go that route at the doctor's office.

Anyway, let us know how it goes!