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    #16
    Originally posted by pb909 View Post
    re: Ampyra
    I was on it so when I went on Medicare I had a decision to make.

    I decided to stop taking it with the advice from my Dr.
    An alternative is going to the less expensive compounded version.
    YES! I forgot about that! I think it's called 4-AP.

    What compounding pharmacy do you use? Has the compounded version worked as well?

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      #17
      I have Medicare part D and was on Tecfidera for a few years. I live in Georgia so you may not see the same plans on Medicare.gov that I do. Be sure to put in your drugs on the plan choices page because not all plans cover all drugs.


      Medicare Part D has what is referred to as the donut hole, a period where there is no coverage. When you have spent the maximum you go out of the donut hole into catastrophic coverage, where your copay is 5% of the drug price. It starts over every year.

      My January copay was about $2300. February was $1700. Every month for the rest of the year was $300. Iím quoting these from memory so theyíre not exact.

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        #18
        Originally posted by Doodlebug View Post
        YES! I forgot about that! I think it's called 4-AP.

        What compounding pharmacy do you use? Has the compounded version worked as well?
        I'm not taking Ampyra nor 4-AP currently.
        Others can advise on compounding pharmacies.

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          #19
          Help with medicare

          Any more info on help with medicare copays? I have been on avonex ten years and have only had a $45 copay with employer insurance. In a couple of months I will be 65 and on Medicare. Am just discovering copays will be $5,000 - $6,000 per year which is shocking. And unaffordable. Does anyone have advice on whether to get original Medicare or an advantage plan? I think I prefer an advantage plan. Way less expensive, 0 deductibles, 0 copays for doctor visits, etc. But copays for avonex...yikes! I fear I may have to abruptly stop the medication. Any advice is appreciated.

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            #20
            Originally posted by hbkat View Post
            Any more info on help with medicare copays?.
            I never did find an answer. I am on Rebif & MS Lifelines covers my copays from my commercial plan. I called them to find out the limit they would cover & all they could tell me was is I were on Medicare I would no longer be eligible. I then asked how much they would pay if I had an advantage plan & they didn't know what I was talking about. I just gave up because they didn't know the differences in insurance plans & it was too hard to explain.

            My husband then questioned whether I even need to be on meds. since I have been stable for so many years. I then started researching & found there's a study currently recruiting for people over 50 & have been stable for at least 5 years willing to go off meds.

            For now I still have my commercial plan, it covers my meds & MS Lifelines covers the copay so no cost to me. I'll keep taking it. When I am forced to pay so much out of pocket I will rethink my course of treatment.

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              #21
              Many doctors who accept Medicare do not accept Medicare Advantage plans. The ones who do may accept a limited number of patients. Donít just look at the list of doctors online, call them. Ask if theyíre accepting new patients.

              My neighbor thought her Medicare Advantage plan was a great deal until she had to switch to a new doctor an hour away.

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                #22
                What if you have suplemental plan addition to Medicare part D

                Hi
                Question for those who already on Medicare , Iím wondering even if you have suplemental plan addition to Medicare part D, still your copay for MS treatment is $4000-$5000 ?!

                Thanks

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                  #23
                  They are two different things. Medicare part B covers office visits and procedures at 80%. This generally includes infusions like Tysabri and Ocrevus. Your supplemental insurance covers the other 20%. Depending on your supplemental plan, the deductible can be any amount from 0 to $2,000+.

                  Medicare part D covers prescriptions that you get from a specialty pharmacy and take at home, such as Copaxone, Gilenya, Tecfidera, etc. There are high copays because the medications are so expensive. You have a REALLY high copay the first couple of months of the year, then you go into catastrophic coverage. At 5% of the list price itís still a lot. Many of the drug company assistance programs are not available to Medicare recipients.

                  It cost me twice as much to be on Tecfidera as Ocrevus.

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                    #24
                    Originally posted by kmallory1 View Post
                    They are two different things. Medicare part B covers office visits and procedures at 80%. This generally includes infusions like Tysabri and Ocrevus. Your supplemental insurance covers the other 20%. Depending on your supplemental plan, the deductible can be any amount from 0 to $2,000+.

                    Medicare part D covers prescriptions that you get from a specialty pharmacy and take at home, such as Copaxone, Gilenya, Tecfidera, etc. There are high copays because the medications are so expensive. You have a REALLY high copay the first couple of months of the year, then you go into catastrophic coverage. At 5% of the list price itís still a lot. Many of the drug company assistance programs are not available to Medicare recipients.

                    It cost me twice as much to be on Tecfidera as Ocrevus.
                    Thank you very much kmallory for explanation
                    In another thread I see that youíre on Ocrevus
                    By any chance do you know if there is any help offered by Genentech or others to people on Medicare to offset the cost of Ocrevus treatment ?

                    Currently Iím still on employer group healthcare plan but in few months need to switch to Medicare and Iím freaked out about cost of my medications on Medicare

                    Your input would be highly appreciated

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                      #25
                      I am currently on Ocrevus. I am not aware of any programs to help with the cost. There may be charitable foundation programs but I generally donít qualify for those based on my income. I found the following just by googling it:

                      http://www.medicarerights.org/fliers/Help-With-Drug-Costs/copay_charities.pdf?nrd=1

                      Since Ocrevus is a treatment, the drug is purchased by the infusion center, and is not a prescription to me.

                      My supplemental policy is a Plan F High Deductible. The premiums are relatively low, about $80 per month. However the $2,000+ Annual deductible has to be satisfied before they pay on anything. That means the first Ocrevus infusion of the year comes with a big bill.

                      There are supplemental plans with $0 annual deductible, but the premium is about $280 per month. So the cost for the year for me would be about the same, just paid differently.

                      For prescriptions, all the manufacturersí copay plans require that you have insurance and that it canít be Medicare. I seem to remember that this is a Medicare rule and not just the manufacturerís policy.

                      If you are shopping for Medicare Part D plans, be sure to use the tool on Medicare.gov. You put in your medications and it shows plans that cover them and shows your annual cost. Not all plans cover all MS meds. Theyíre not required to.

                      Good luck with your search.

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