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Betaseron and Medicare

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    Betaseron and Medicare

    Mom's going from platinum coverage that included her meds to a Medicare Supplemental. Bayer doesn't offer co-pay assistance with this scenario. The med is 5000+/month. Suggestions beyond buying a scratch ticket and hoping for a miracle?

    #2
    Originally posted by Baker298 View Post
    Mom's going from platinum coverage that included her meds to a Medicare Supplemental. Bayer doesn't offer co-pay assistance with this scenario. The med is 5000+/month. Suggestions beyond buying a scratch ticket and hoping for a miracle?
    Hi Baker258,

    First thing I should mention is that others should have a better handle on the info I am about to offer... and Hopefully they will respond to your question.

    My information is current since I'm about to turn 65 this spring. Being in the same situation as your mom I was scared.

    This is how I understand it to be.

    My "C" cost, $5.5k @ mo, ( now covered entirely by my BCBS ) will immediately put me in the infamous Medicare "donut hole," the first month my prescription drug plan takes effect. You will only pay a % of your drug cost that month, a smaller % the following month (when you enter catastrophic coverage) and the following 10 months only a very minimal %. Using my case....

    this means that "out of pocket" costs, for me yearly, for my C will run about $6K.

    Add the part B and the supplemental insurance cost will run another $2.75 to $3K a year.

    A total of under $9k.

    So your mom will need to purchase a prescription plan who's formulary carries her drugs (Original Medicare, not an Advantage plan, which I know little about). These plans usually have a monthly cost ($20 to $40 but can go much higher).

    The main thing is—the expense of the drug(s) you need to cover will immediately put you in the position described above. I know it still isn't cheap, but considering what I believed I was up against, it actually worked out a few hundred $s cheaper than my latest BCBS policy.

    Hope this helps, Visit Medicare website for great plan presentations,

    Jer

    Comment


      #3
      Hey Jer:

      Thanks for responding.

      You explained it very well. The first month is the most like 5K, then it goes down to 1000.00 for the second month and according to the stupid formulary search it'll be about 275.00 each from March-December. For Mom it's a Tier 4 drug, the top ring.

      I was hoping there was some angel program that could provide co-pay assistance.

      As for the donut hole-like who came up with that?-Mom has a more expensive Part D plan that includes donut hole coverage.

      I was told that Part B doesn't cover Beta because it's a self-injectible as opposed to other meds that require a doctor like Avonex. Mom has been on Beta since she was diagnosed. Is that true about Avonex-it's a skilled nursing injection...or perhaps that's how it's coded in the System.

      Bayer...c'mon!! Don't be discriminating against seniors!!

      Comment


        #4
        False!

        Avonex is also a self-injection.

        I found on Medicaid that I had to send in a special letter from my neuro to get Beta paid for. Their formulary lists Avonex as the first line drug. When I moved to a new state and they didn't want to give me information beyond Beta not being covered, I went to Bayer. And then I joined a medical study that gave me a different interferon for free for a year.

        Fight this. They gave you incorrect information, so I would be that the insurance person with whom you spoke doesn't know what they are talking about. Get your mother's neuro involved, too. The neuro or the MS nurse in the office likely will have had experience with this.

        I got far more information about how Medicaid works from various employees at my neuro's office than I did from the Department of Human Services.

        Also, you can contact the various MS foundations to ask about funding for the MS medication. There are a couple foundations apart from the drug companies that have funding available.

        Comment


          #5
          Similar situation

          .
          I use to have insurance through my employer. They capped our RX's at $1500 per year (so after the first month I pd -0- . When I went on SSD I was a able to take my former employer's mdicare and retiree insurance plan. Although I had to pay the very high cost of $1244 a month to cover both my husband and myself, my out of pocket for Rx's was still $1500. Now my former employer is discontinuing the retiree insurance so I have to shop around.

          I'm finding that alot of the prescription plans won't cover between. So far the best I've found is for me to take a part "N" medical plan costing $166 month/ $166 deductable/ $20 Dr co-pay. Then to that I would add a part D prescription plan through Silver Script. The cost would be $28.50 per month.

          I use betaseron, ampyra, vesicare, and lexapro. My cost in January for the four meds would be $2,800, which if I understand correctly, jumps me right over the "donut hole". I would then pay $385 a month the remainder of the year for prescriptions, as well as the cost of the medigap, part D and part B costs. This is still I my opinion a substantial amount of money (approx. $10,500 for the year). This is just for me. We still need to purchase insurance for my husband.

          On my previous plan through my former employer the total cost for both of us was just under $15,000. My husband is self employed and will be turning 65 in February. I don't get why the drug companies are willing to give patient assistance to those with private insurance and make it near impossible for those of us who are on Medicare. In order to qualify for help you have to have almost no income and retirement savings. They don't take into account that you may still have a mortgage and that because you run out of money halfway through the month you've maxed out most of your credit cards just to eat and buy necessities. OK.. enough ranting. So stressed.

          ** Moderator's note - Post broken into paragraphs for easier reading. Many people with MS have visual difficulties that prevent them from reading large blocks of print. **

          Comment


            #6
            Originally posted by balance View Post
            I don't get why the drug companies are willing to give patient assistance to those with private insurance and make it near impossible for those of us who are on Medicare.
            It isn't that the drug companies aren't willing to give patient assistance to people on Medicare -- by law, they can't.

            People who are enrolled in Medicare are bound by the rules of Medicare (which are actually federal laws). Drug companies have contracts with Medicare that contain pricing agreements. After the companies have contracted with Medicare to provide medications to Medicare enrollees at the mutually agreed-on prices, it is illegal for the companies to then violate the contract by undercutting the prices by undercharging Medicare enrollees and overcharging Medicare.

            Comment


              #7
              Thanks

              Thanks for clarifying for me why patient assistance isn't available for those of us on Medicare. Does anyone else find the cost of their prescriptions to be staggering?

              How do you all manage because I feel terribly overwhelmed.

              Comment


                #8
                Part D Pharmaceutical Assistance Programs

                You may be able to find some assistance.

                Go to the Medicare.gov website.

                Click on the Drug coverage (part D) tab

                Click on the Cost in the coverage gap tab

                On the right side of that screen you will see 6 Ways to lower your costs in the drug coverage gap

                Listed are 6 ways to lower your costs.

                Number 3 has a link for Pharmaceutical Assistance Program.

                Hope you find some help!

                Comment

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