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Longtime Xolair patient here: as far as cost goes, there are copay programs that knock the price down to $5/mo, but the catch is that you have to be insured (via commercial health insurance, not Medicare/Medicaid) to qualify.

A lot of drug manufacturers offer these programs: the bargain is essentially that they'll cover the brunt of your copay cost so long as your insurance company is still paying for the rest of it. Better to collect a few grand from the insurance company and reimburse the patient for a few hundred than to miss out on the sale entirely.



I'm surprised that the commercial insurance policies would tolerate this kind of copay kickback, since it arguably induces patients to be less discriminating based on their own financial skin in the game.

The federal government treats these as illegal kickbacks: https://oig.hhs.gov/documents/special-advisory-bulletins/878...


I’m on a similar expensive (per sticker price) medication. After insurance pays a few thousand, they leave me with a $6,000 bill. But I’m on the manufacturer’s discount plan so I actually only pay $5. However, my insurance still thinks I paid $6,000 out of pocket, which very quickly eats up my deductible for the year.

It feels wildly perverse. I’m incentivized to purchase this “expensive” medication once or twice and then the cost of all of my medical care the rest of the year is negligible.


So hard to believe that this is so complicated. People’s lives and health. I wish it was easier.


Move to Australia? On a script, cost is AUD $31.60 per syringe, a rather stark saving from $410 . I wonder how that latter price compares to the price in the US, I couldn't quite get the prices I read without insurance to compute in my head.

https://www.health.gov.au/ministers/the-hon-greg-hunt-mp/med...

https://m.pbs.gov.au/medicine/item/10109c-10110d-10118m-1012...


> I wonder how that latter price compares to the price in the US

My guess is not favourably for the US. My wife was diagnosed with MS about a year before we moved to America and, since I knew we were moving and was thinking about insurance, I asked the pharmacist once what they billed the govt per dose (monthly). We paid $40 out of pocket and the govt paid $1300 AUD.

Our insurance in the US pays nearly $10k USD/m for the same drug.


No wonder why I couldn't process it; this sounds like a complete rort - it's just mind boggling.

More importantly, wishing you and your wife resilience, strength and as much good luck in health as is possible for your journey ahead.


It still costs the government AUD $221.57 (minus $31.60). So it is still pretty expensive, it is just being paid for collectively.




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