Posted 1/21/2023 7:50 AM (GMT -8)
Gotcha! Just further fyi- Medicare doesn’t have any so-called “step” therapy requirements. Medicare itself is no hassle no worry. Infusions and their medications are covered under medical, not prescription. Medicare makes the rules and sets prices for supplements across the board so individual supplements cannot dispute any charges IF Medicare pays. Only once have I had Medicare refuse to pay — for a blood test. I appealed but they didn’t listen. But with everything they pay on my hospitals, drs, and infusions, I’m certainly not going to gripe about the $200 out of pocket. None of the drs I’ve encountered have refused Medicare but I know that some do.
The prescription side is a bit if a bummer but there are a few positive changes coming like a yearly cap. But I’ve found work around most of the time using Costco and good Rx, and getting some meds free from manufacturers My monthly meds (omeprazole, statin, my husbands blood pressure med) are all no cost. My thyroid pills are reasonable. UC meds are crazy expensive though. Curious how mark Cuban can sell them so cheap compared to the drug plans. I’ve come to the conclusion that it’s not so much drug manufacturers as the insurance plans and pharmacies that are taking it in. How else can there be such a huge range in price from different pharmacies for the same drug. CVS for instance charged $350 for a med you can buy at Costco for $50 retail. Anywho I digress.
Crossing my fingers for you! I know the stress. Entyvio is supposed to be going to self injectables in the US maybe this year and I’m already starting to worry about that.
My dr said I should be able to stay with my infusion but we’ll see.