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    Medicare co payment assistance programs

    I've been on the Biogen Free a Drug Program for 4 years and they just kicked me off of it. They are starting me on a co payment assistance program and I'm scared. The hospital where I get my Ty isn't set up to handle all of these assistance programs and I'm afraid I'm going to get a giant bill that I can't pay.

    This is stressing me out, not only because I'm afraid of a giant bill, but because I don't know how to go about ordering the medication every month. Every time I call Bioben, I'm on the phone for an hour as I get put on "brief 2 to 5 minute holds" one after the other.

    Does anyone else have Medicare who can advise me on how to navigate Biogen with a co pay assistance program?

    #2
    palmtree -

    I was hoping someone would reply to you. I also am on Biogen's assistance program, they pay all except $10 of the infusions. Before that, my insurance company charged me $981 and then a wooping $2000 for one infusion. It was a huge fight with my insurance company to get them everything they needed, and they did so only after I filed a formal complaint. So far, Biogen has renewed it each year.

    In another year and a half I also will be on medicare and I am wondering how that will work. I wanted to bump this up to the top so maybe you will get an answer to your question.

    When I was going though all that, I found emailing was better, plus I could then print out the emails and when I did do calls, I have names and numbers that I could easily give them. It was an 8 month battle that I would not want to go though again.

    Has anyone gotten back to you with any sort of answers. Do you just have basic medicare or do you have supplemental insurance too? I am just starting to learn about all this stuff and it is overwhelming. Have you tried calling the medicare office?

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      #3
      I'm 2.5 years away from Medicare, but my understanding is that Tysabri infusions are considered under medical part B. It covers 80%, but if you have a supplemental insurance that covers the other 20%, there should be no charge at all to you. When you sign up for the supplemental it's important to remember, they CANNOT refuse to take you. However, it would still be wise to shop around for the best deal.

      Someone please let me know if I'm wrong in my understanding so I can plan ahead.

      Comment


        #4
        Hi all,
        when you get your supplement you need to get plan "F" to have it cover the 20% ..
        Linda

        Comment


          #5
          Going off Tysabri

          My Tysabri infusion was to be next week. Is anyone else having problems getting co-pay assistance? I am. I like Tysabri. It is working. However the co-pay assistance rug has been pulled out from under me. I blame Biogen.

          I was on assistance from grant. Money ran out. I knew this was going to happened months ago. So did my infusions nurse so we were proactive and applied for free drug program that would start this month. Biogen sent me letter that I qualified for the free drug program until my grant funding had been processed and paid. Then I would reapply. . Yesterday they called and told me that they were not doing briding the funding gap anymore but gave me a connection to another funding source. I qualified. BUT - I cannot get that funding until the other funding has been "exhausted". Problem is that even though I do not have enough m funding for more infusions, records show that I have $3,700 because the claims are still in the pipeline and the money has not been paid. The reason is that it takes about 60 days for claims to be processed by Medicare and another 30-60 days for the copay assistance to go through. Then I have $300 left, which doesn't cover but +/- 1/3 of my co-pay. I can not afford the $800 difference.

          My infusion nurse is battling with Biogen to get my Tysabri for free until I can get the funding issues taken care of. I decide to call too. The Biogen assistance program representative looked into my situation and told me the only options I had other than to pay out of pocket was to call Medicare and ask them to ask them to expedite the claims and to keep calling. I told him I wasn't going to do that because it would just take away Medicare's time, my time and why would they bump me above others? Medicare is already understaffed and underfunded - downsizing by attrition. I'm not blaming Medicare or asking favors. I have traditional Medicare and monitor EOBs. If billed correctly it takes 30 days to process and another 30 -45 to pay. I've never had a claim unpaid for over 90 days unless there was a coding error.

          So, no money, no medicine. ObamaCare itself doesn't have anything to do with this. Perhaps Biogent playing politics does. Some people may cry "fowl" but the only impact that law had on me personally was a smaller donut hole. Lots of problems with the ACA but traditional medicare is not a part - the advantage plans are hiking rates - that's why I went back to just Medicare. I have 101 problems but Obamacare ain't one. Being told "we want to make sure you have your medication so here it is". Then less than a week before my infusion I'm told "nope".

          I've heard there was a "kick-back" or relapse when Tysabri is stopped. Is that true?

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