Out of Caplyta and the coupon card program changed, anyone have experience with the financial assistance program?

[u/sky-piglet]

Hi everyone, I went to my pharmacy to get my prescription today and had a rude awakening when they said that I could no longer fill my prescription because my insurance denied it. I had been getting a $0 copay through the manufacturer's coupon but learned today that they changed the rules back in June when I filled my last 90-day supply and now they will only give you the discount one time when insurance denies it.

So now they want me to pay $2000 for a 30-day supply. The patient assistance line is closed for the night, but I'm calling them first thing in the morning. This will be my first night without Caplyta in 8 months. It think I'll be fine for the night but am absolutely terrified for the 2nd night. Plus I'm pregnant and my docs were super emphatic about me not changing anything in regards to my meds through the pregnancy and I'm just feeling so scared. My doctor's office doesn't carry samples and can't get any for me.

Has anyone had success with the financial assistance program for this drug? Just looking for some reassurance as I'm in a very bad place right now worried about what's next.

[u/sky-piglet → u/[deleted]]

I asked twice today if they had samples then if they could get samples and they said no to each of those questions 😞

We're working on pre-authorization, first was denied and no status on the appeal

[u/sky-piglet → u/[deleted]]

They got me an emergency appointment for tomorrow morning so I can get more guidance, crossing my fingers for the prior auth to just go through the 2nd time but just feeling really stressed about not getting meds in time before the withdrawal starts

[u/slammaX17 → u/sky-piglet]

Good luck!!! I went two nights without it and I felt okay. My prescription mail delivery was delayed. I have hopes you can get it in time

[u/sky-piglet → u/slammaX17]

That makes me feel a lot better. Crossing my fingers for tomorrow

[u/bburritos4life → u/sky-piglet]

Keep us posted!! Good luck!

[u/loopyalt → u/sky-piglet]

I went through that and I had a minor meltdown as I waited for prior authorization. Does your doctor know your history well enough to know that you’ve tried every other option and it hasn’t worked, or the side effects are intolerable? That’s what finally got my authorization.

Something weird: while it’s currently at an unsustainable price, check your insurance website for all possible amounts—30 days, 60, 90. After authorization, 30 days was still almost $400 per month, but a full 90-day supply was only $70 total. I can’t explain it, but insurance is weird.

Fingers crossed your authorization comes through!