Tysabri and Medicare

[kmallory1]

The confusion may be coming in because Humana is looking at this as a drug prescription.

Tysabri CAN be dispensed by a "specialty pharmacy" as a prescription and shipped to your chosen infusion center, where you're charged just for the infusion.
I chose to have Tysabri dispensed this way because it was cheaper under my group insurance plan.

More commonly, it is prescribed as a "treatment" by your neuro, and the drug itself is furnished by the doctor's practice as part of your treatment. Then it doesn't come under part D, just part B and your supplemental. Or part C if you're going with HMO. I think. I don't have a great understanding of the B and C thing.

I'm going on Medicare in the spring and DREAD it. It's got to be the most confusing medical plan ever.

I'm off Tysabri now after 43 infusions (positive for JC virus).

[lira1314]

I UNDERSTAND.. CALL TYSABRI SERVICE AND YOUR CENTER SHOULD ACCEPT MEDICARE----DR

I am on Tysabri and I start Medicare in Oct. I almost fell over when I found out how much it cost on Medicare. I am going nuts, I can't afford this! I know that Ty will help you, but the infusion center won't. I don't qualify for low income.

Does anyone have any ideas? I am new to Medicare and don't know the in's and out's. Is there a way to get help for a something this expensive when you aren't low income. I don't have the money to pay for treatment and have to much for help, what a predicament!

[khs]

i know what georgiapug means

i am in ky and also was told no gap plan for under 65's. on the ssi website i searched for a gap plan anyway but the plans were only numbered and i could not open- no info was available to me.

the medicare advantage plans do pay same% as medicare. the "advantage" is that the ins negotiates a lower rate and the 80/20 split is on that lower rate.

i also have humana and can not go to a "hospital" for anything. for instance an mri has to be done at a "freestanding" clinic (meaning not associated with a hospital).

problem is in my area almost everything is associated with a hospital "system". and they dont tell you this when you take the ins. i was only given a range starting with a $35 copay which i later was told meant if your neuro had an mri machine in his office. yeah, that happens.

my last mri was done on a machine that looked old, was very small and according to my neuro looked like a .75 tesla. and it was still $75 to me.

i was refered to an excellent pt clinic which Hum said was covered then the clinic called and told me the copay would be $100 PER VISIT and i needed to come three times a week.

FOR TY, even at only 20% i would have to pay a hospital copay in addition and it would exceed my total income. the assistance programs i looked at have only been for those with NO insurance. tried to speak with my neuro about alternatives like ldn or 4ap and he would not help, said "you just have GO HOME and learn to live with it". my caretaker will not drive me to larger city to see someone else. i am classified as severely disabled with PRMS and have been progressive for over 12 years (worked for 8 years of that time. i make $21 a month too much in disability according to ssdi to get medicaid.

will be moving to georgia soon to live with my daughter and wait to die. i am 57.

[Myoak]

Effectiveness of tysabri

Hello,

For Samantha and others who may be wondering about the effectiveness of Tysabri .... it reduces the number of lesions showing new disease activity by 92% compared to placebo.

My wife was in the Phase 3 study of tysabri begun in 2002 and has received monthly infusions ever since, except for the brief time when it was not available. Next Mon. (10-11-10) she will receive the approx. 90th infusion; and has done very, very well throughout.

Good luck to each of you as you clarify your treatment and insurance concerns. May peace be your constant companion as you resolve those issues. Special hi to lindaincolorado, hope you are doing well.

[Lendi]

All of this is really confusing. I appreciate all of you posting as I will be going on Medicare in Jan (in KS)

Tysabri started out, for me, with assistance from Touch, and a co-pay of $10. an infusion and I paid the the infusion site charges.

Then, all of a sudden (same insurance) it changed to my insurance picking up all of it because they consider it an injection which they don't have co-pays for. (I have Blue Cross) Same insurance as before and I wasn't even close to my major med. deductible being met.

They don't add either the med or the infusion site into my $2000 yearly deductible, either it's as though it's in it's very own league.

My neuro told me that tysabri is "the big guns", putting rifle against a machine gun, than the injection meds and that the oral pill that just came out (?) is more in the league of the shots.

I hope what I wrote made sense, LOL. Sometimes my mind and fingers don't quite blend when I'm typing.

[eileenmclain]

Medicare and tysabri

Dear Georiapug,
I just received my first Ty infusion 5 days ago. I have Medicare. I'm only 57, but have been on disability for a couple of years due to MS and type 1 diabetes. I always balked at the Medigap option, because I was getting Rebif for $50 per year from the MS Lifelines patient assistance program. Most of the MS injectables have patient assistance programs though. I was also on Avonex for a year, and Avonex got me on their P.A.P too.
2 months ago I got supplemental ins. and I only pay $70 per month for the Medigap Plan "N". That was the only inexpensive option in Lake County, Oregon.
Medicare Part B picks up the 80% and the Medigap picks up the 20%. Pretty good deal, and then most of the other medical stuff, like physical therapy is covered by the supplemental too.
The Medigap company was United of Omaha, and I had no problem getting it even though I'm not 65. Talk with the TOUCH program counselor and he or she will work with you to get something figured out. Seems I always fall through the cracks too, so I know how you feel. You might have to do some research, phone calls and internet searching, but help is out there ! Hope this helps some.

[REG53]

Hello Georgiapug, I am under 65 and on disability. I have recently went on medicare. I have been told I cannot get a supplement, I have to get a medicare advantage plan and it looks like my only option is humana. I have an ins agent looking into the information for me. I am also on TY and I do not want to come off of it.

Please keep us posted on what you find out and I will do the same.