Specialty drug copay assistance revoked due to “Maximizer / Variable Cost Savings Plan”

Prescription Drug Benefits

Hi! 25F who doesn’t understand insurance very well and needs some help. Last year, I switched to my employer’s AETNA healthcare plan where specialty drugs such as my Ocrevus infusions for MS are “handled” through my pharmacy (insurance?) OptumRX.

Long story short, I received a call from OptumRX saying I owe $1400 for my Ocrevus. Genentech (the copay assistance provider for Ocrevus specialty drugs) took away my copay assistance (although they covered my Ocrevus infusion this past June) due to me being enrolled in a “maximizer/variable cost savings program” sometime between my last infusion in June and now. They mentioned they will only cover up to $125 worth of drug administration fees, despite having ~$13k of total copay assistance remaining for this year.

I do not recall ever being signed up or willingly signing up for this and I’ve spent countless of hours on the phone with both AETNA and OptumRX and they have no record of me being enrolled in this “maximizer/variable cost savings program” in their system. Genentech stated that I am, and it is showing up as a flag in their system, and I need to provide a Benefits Summary/EOB showing that I am not enrolled in this program. OptumRX is claiming they don’t have anything like that and AETNA had to “draft something up” and fax it over to Genentech, but I never ended up receiving it after being promised I would.

I’m finding it difficult to believe that I somehow without my knowledge got enrolled into an (anti) cost savings program through my insurance without my knowledge after no change to my insurance over the last year. No one on the phone from OptumRX nor AETNA have been able to help me.

What can I do in this case? I’ve spent a cumultive 10 hours on the phone (conference calls included between Genentech/OptumRX/AETNA) and no one has been able to help me.

Posted Nov 14, 2025, 7:05 PM UTC

24
Loading comments…