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Thread: Medicare supplement insurance and MS special meds

  1. #11

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    I am one of a few that tried cellcept
    For ms with success. I went to the
    Manufacturer genetech and asked for
    And granted financial aid. That was up
    Until now. I was I informed my prescription
    Plan would pay for a portion of the
    Brand name mofential? Sorry but you'll
    Easily be able to look it up. I can't
    Imagine what they want. My sybthyroid
    Went up to $'28. What?!! Bottom line
    Is Medicare is your health insurance then
    You need to sign up for a drug plan-Just tread
    Lightly. You probably do NOT want a supplemental
    Pk as n. Look for a PDP Prescription plan.
    Read up on plans here and other sites before
    Signing on. I'm not intending to scare you. Basically
    Just remember I believe you want a PDP DRUG PLAN
    NOT MEDIGAP OR SUPPLEMENTARY so know the
    Difference before you decide. Hope that makes sense.

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  3. #12
    Distinguished Community Member Sunshine's Avatar
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    Petpuppy what is a PDP plan?

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  5. #13
    Distinguished Community Member agate's Avatar
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    A PDP plan (prescription drug plan) seems to be the Part D Medicare plan many of us chose some years ago when we almost had to do that, when it first came along. It's what I still have though I don't have to pay the monthly premium.

    prescription drug plan (PDP)

    A prescription drug plan (PDP) is one option for individuals who want to enroll in the Medicare Part D prescription drug coverage, which subsidizes the costs of prescription drugs for enrollees. A prescription drug plan (PDP) is a stand-alone plan, covering only prescription drugs. Enrollees who choose the option of prescription drug coverage through a Medicare Advantage plan would also have coverage for other medical expenses as part of that plan.
    Enrollees pay a co-pay for each prescription, a monthly premium and an annual deductible.
    --from https://www.medicareresources.org/glossary/letter/p/

    I was on a Medicare Advantage plan through United Healthcare for a while until I found that I could go off it but stay on the PDP if I switched from the PPO to the HMO version of United Healthcare. It was a way of getting out of paying the premiums BUT it also limits me in some situations. I have to stay with in-network medical providers sometimes.

    petpuppy, please correct me if this isn't what you meant about the PDP plan.
    Last edited by agate; 01-12-2018 at 09:05 AM.
    MS diagnosed 1980. Avonex 2002-2005. Copaxone 6/07 - 5/10.
    Member of this MS board since 2001.

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  7. #14
    Distinguished Community Member Cherie's Avatar
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    There are no Medicare Part D plans that cover self administered DMTs fully. You pay 33-40% copay and since all of those drugs are now more than $6000/month, that is a hefty co-pay. Federal law restricts any of the drug companies from helping with co-pays in anyone on Federal insurance programs. If you make under $70,000/year as a couple or $35K as an individual, you may qualify for some foundation assistance in covering co-pays. Your doctor's office and the drug company helpline nurses all have numbers that you can call to apply.

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  9. #15
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    BBS, my new Doctor does not want me on Rituxan or Ocrevus because of my age. It can deplete B cells which can then lead to infections. It is more likely to do so in someone my age because my immune system is already lower.
    Virginia

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  11. #16
    Distinguished Community Member Sunshine's Avatar
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    That makes good sense Virginia.

    Cherie, that kind of copay is impossible for 98%of Patients. And ridiculous. Why would fed law forbid pharma from helping patients on fed insurances. GEESH.

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  13. #17
    Distinguished Community Member agate's Avatar
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    In case this isn't generally known, there are some Medicare savings programs built into Medicare.

    https://www.medicare.gov/your-medica...-programs.html
    MS diagnosed 1980. Avonex 2002-2005. Copaxone 6/07 - 5/10.
    Member of this MS board since 2001.

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  15. #18
    Distinguished Community Member Cherie's Avatar
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    Quote Originally Posted by BBS1951 View Post
    This quote is hidden because you are ignoring this member. Show Quote
    That makes good sense Virginia.

    Cherie, that kind of copay is impossible for 98%of Patients. And ridiculous. Why would fed law forbid pharma from helping patients on fed insurances. GEESH.
    Well, the LONG story is that Senator Ted Kennedy (D-MA) tried to stop the drug companies from giving golf vacations and luxury weekends for continuing education away to docs so wrote legislation that was adopted stating that No Drug company is allowed to give anything away to entice a prescriber to treat with their medication or patient to go on their medication. 2 years later, his nephew Patrick Kennedy (D-RI) got the same legislation passed in Rhode Island. Upon review three years later the Senate put that caveat into the affordable care act so it became Federal Law but only applied to those receiving governmental insurance (Medicare and VA specifically , but in some cases Medicaid) I spent $7700 on copays from October when I went on Medicare in 2014 to February of 2014 on Just Rebif Co-pays. We were borderline to receive foundation assistance as our income was relatively high but because our health care premiums were nearly $1800/month with the addition of the huge DMT copay, they slipped us into the program. I was already under catastrophic coverage where one only pays 9% of the cost of the drug as a copay but it was still more than $800/month). This is one very good reason for you to get to know your senator and representative and let them know how healthcare legislation personally impacts YOU! BTW this law refers to all Medicare and VA recipients receiving copay assistance for ANY condition where a specialty drug is the only course of treatment.
    Last edited by Cherie; 01-14-2018 at 08:10 PM.

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  17. #19

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    I would like thank everyone again for helping me. Nothing has changed. I still haven't been able to get copay assistance, My husband is still working full time so I am going to pay for the Extavia and the Ampyra this year. I am going to continue researching what happens to people my age that go off their MS meds and maybe take the plunge next year. Both companies say the don't give copay assistance to someone on Medicare. My neurologist is comfortable with me going off the Extavia. Ampyra will have a generic coming out this year hopefully.

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  19. #20
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    Thanks for coming back and letting us know, Bookfairy.

    ANN
    There comes a time when silence is betrayal.- MLK

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