I have a pharmacy card that I only have to pay a $10.00 copay for generic drugs and $30.00 copay for Brand name, which I am very happy with, since I have had a variety of meds in the past.

I am now starting a new drug, Humira self injections twice a month. They are very costly and I will be responsible for about $230.00 per month for these injections. I guess I don't understand why they don't fall under the copay rules for pharmacy meds. I have searched my policy on this and cannot find an answer. I am currently waiting to hear back from my insurance company on this.

Anyone have any answers?

Humira is a very expensive drug, and many insurance companies do not cover the drug at all, or charge higher copayments.

Most insurance companies offer "tier" formularies. Drugs in the first tier cost the amount of your brand/generic copay. Drugs in another tier have an added cost. It's not uncommon for insurance companies to have 4 or 5 tiers, each tier costing the patient a little (or a lot) more. Also, many companies have a higher tier just for injectible drugs like Humira.

While it's unfortunate, it isn't uncommon.

Sheridan is correct.

Take the reference below to you local medical library and ask them to get you a copy of the article.

Manag Care Interface. 2001 Jul;14(7):49-51.
Coverage inequalities of new therapies for rheumatoid arthritis in a managed care setting.

This may give you some better insight surrounding your specific issue.

Additionally, many insurance companies require step therapy meaning the doctor is required to prescribe medicine A and B and you must fail on those meds first before he can prescribe Drug C. So check that out and make certain that your doc has followed any rules that might be in place.

If you can't afford it, please be aware that many pharma companies have patient assistance programs that do not require that you be destitute to participate.

Take care---