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Humana no longer covers my Mycophenolic Acid (Myfortic).  Nor will Medicare Part B because I wasn't on Medicare when I had my kidney transplant back in 2005.

I pay $222.00 out of pocket for my monthly supply - (360 3x daily).  My kidney is in rejection after 12 years and this medication is keeping my kidney stable for the

time being.  If I am forced to pay the cash price for this medication it could cost me a minimum of $600 plus per month.  There is no way I can afford this plus

my monthly expenditures.  Any one of you have a similar issue?  Would really appreciate your suggestions.

Robert Heller

Port Richey, Fl

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  • Try SCBM in Austin Texas they are advocy company. I paid $600-$790 per month for valcyte and $300 to $400 per month for trajenta I received free for one year cost me $50 per month for Mgmt b them.

    If you make over $150 K per year will not qualify
    • Good morning Robert and thank you for your comment and suggestion.  Since I posted my initial comments about Humana no longer covering my Mycophenolic Acid 360mg I applied for assistance with Novartis Pharm and their patient assistance foundation.  They contacted me and also spoke with Humana regarding my issue.

      Bottom line they will continue covering my med through 2/22/18 and that's it.  After that my cash cost for the med will be $900.  They also suggested I contact my physician and have him submit a "PA" (Prior Authorization) to Humana and when submitted Humana will continue to cover my med through 2018.  Well it all sounds good, but I'll wait and see what transpires.  God Bless

      Bob Heller

  • Everyone getting a lawyer is a key reason things are too expensive. Write, call and pester dept of insurance and news media.
    • Not a good suggestion
    • I think greed is a much bigger factor.  Still, I can certainly agree that being "sue happy" is a problem these days.  But just deciding not to cover a med that is keeping him alive is off the mark.  Especially when you consider is one of the "cheaper" rejection meds. 

  • The more I think about this, it just makes me ANGRY! 

    I'd have to consider legal action at some point.  Surely there is a good ambulance chasing lawyer that could sue for "mental anquish" or some civil damages.  All you need is a few jurors to see it your way.  Maybe loosing few million would help Humana see the error of their ways.

    • Few million is zero loss when you make mega billions
  • I'm sorry to hear this.  With the state of our Med system - we must get use to this.  We / I are forced to go on ACA in 2018 and it's an incredible amount for lousey coverage.  What started out as a good intended effort has gotten out of hand and I just don't know who is looking out for us (Dept. of Insurance?)

    I am a kidney tx guy and on Mycophenolate Mofetil 250mg x 4 daily.   A 90 day supply from (US based) is ~ $353.  When pricing out my insurance, I was thinking at one time to go cheap and buy my Rx myself (through this place are ~ $2300 / year).  The savings didn't make sense.

    My point, you should consult with your doc's if this would be an acceptable substitute.  I'm not comfortable buying Rx from Canada, India, where ever.  The doc's know what is going on with healthcare.  In my town, Cleveland, OH, many are going to leave one hospital system and go to the larger as one of the ACA plan requires 50% co-insurance for specialty Rx (and of all the plans, that policy is the only one that list these generics as specialty -- again, who is looking out for us?).

    Good luck.  You still got a gift but heck, not must be an insurance / benefits management expert as well.

    • Thanks for the info George...Is there anyone in the Tampa Bay area experiencing the same issue I am?  Happy New Year George

  • Health Ins. providers should by law be required to payout on a life ins policy if you die.  That way they MIGHT care if we lived or not. 

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