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Real members of myPHteam have posted questions and answers that support our community guidelines, and should not be taken as medical advice. Looking for the latest medically reviewed content by doctors and experts? Visit our resource section.

Is Anyone Having Problems With Getting PH Specialty Meds Authorized For 2025? I Am.

A myPHteam Member asked a question 💭
Tucson, AZ
November 26, 2024
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A myPHteam Member

I was prescribed Adempas. I’m newly diagnosed. I was totally blown away by the cost when I read about it online. I filled out paperwork, actually I didn’t fill it out, my doctor’s office did, I just signed. Then CVS Caremark, the drug company, and insurance company got to work and whittled the $$ to $75/month copay. When told that, I asked CVS Caremark if there was any help or coupons, whatever. They said to call Healthwell Foundation they might help. Sure enough, they are a grant funded organization and are covering the $75/ month for a year. I just have to reapply each year. They said they would cover me for up to $10,000 /year. By the way, I have Medicare and Federal BCBS and am fortunate to have decent pension and SS$. So it is not income based.

November 28, 2024
A myPHteam Member

Thank you. Yes, I did do that, I checked online for the 2025 list and it’s there, but still would need doctor pre authorization showing it’s necessary.I also spoke with the Caremark nurse this morning who reassured me that if the medication was necessary that both pharmacy and insurance would work it out (my words) not hers.

November 29, 2024
A myPHteam Member

The only thing I’ve gotten approved was sildenafil. Jumped through hoops for that. I was ready just to buy it through GoodRx.

November 26, 2024
A myPHteam Member

Unfortunately, the medications to treat PAH are priced quite high. This can be quite discouraging and anxiety provoking. There are several foundations that can provide assistance including The Assistance Fund, PAN Foundation, and Healthwell. Other sources for Tadalafil or Sildenafil to check out are Mark Cuban's Cost Plus Drugs and GoodRx. The PH Association also has resources available on their website.

December 6, 2024
A myPHteam Member

@A myPHteam Member That's great! Glad you will be getting the extra help.

December 5, 2024

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