Medicare Prescription Payment Plan

[kgmom219]

Thanks for getting the thread back on track, good info here for all the naysayers.

Catching up

You’re right. In theory, this will be fabulous news for people on Humira. (Not sure why you didnt move them to an infusion center, covered under B, or why no one else thought to ask, but I digress.)

This is a really good example of listening to you elders.

The ones on here laughing at this plan have 20+ years of experience dealing with scenarios just like this one.

DC decides that XYZ needs to happen in health insurance to help consumers.

Insurance Companies (who are always 10 years behind in technology) scramble to implement XYZ.

XYZ completely bombs at the carrier level in years 1 and 2 and its chaos until year 3.

Pharmacy staff will be clueless because they are never in the loop.

Clients then yell at agents for the recommendation. And pharmacy techs. And at their insurance company. It’s super fun!

The idea is fabulous.
The implementation will be a nightmare. “But I’m paying the $160 a month! Why do I owe money at the pharmacy?”

Listen to you elders. Advise against it, but if the client still decides to try it, then it won’t be your fault.

 

[somarco]

(Not sure why you didnt move them to an infusion center, covered under B, or why no one else thought to ask, but I digress.)

If the person is on MA then Part B drugs (often) require 20% patient coinsurance with much higher OOP than OM Part B + Medigap G

 

[straightnochaser]

Catching up

You’re right. In theory, this will be fabulous news for people on Humira. (Not sure why you didnt move them to an infusion center, covered under B, or why no one else thought to ask, but I digress.)

This is a really good example of listening to you elders.

The ones on here laughing at this plan have 20+ years of experience dealing with scenarios just like this one.

DC decides that XYZ needs to happen in health insurance to help consumers.

Insurance Companies (who are always 10 years behind in technology) scramble to implement XYZ.

XYZ completely bombs at the carrier level in years 1 and 2 and its chaos until year 3.

Pharmacy staff will be clueless because they are never in the loop.

Clients then yell at agents for the recommendation. And pharmacy techs. And at their insurance company. It’s super fun!

The idea is fabulous.
The implementation will be a nightmare. “But I’m paying the $160 a month! Why do I owe money at the pharmacy?”

Listen to you elders. Advise against it, but if the client still decides to try it, then it won’t be your fault.

Humira is a Part D covered drug, there is no coverage under Part B

 

[kgmom219]

Humira is a Part D covered drug, there is no coverage under Part B

Thanks so much. I had no idea.

There IS an infusion option for both Humira and Enbrel, covered under Part B. Tell the client to talk to her doc. Assuming G/D, you just saved her $3500 this year and $2K next year. If you put a person with a diagnosis requiring Humira on an MAPD, I got nothing. PAN Foundation?

Keep being a know it all, who is so green he didn't know how to use the search button on the forum to help save his client money. There's multiple threads on Humira/Infusion Alternative.

 

[straightnochaser]

Thanks so much. I had no idea.

There IS an infusion option for both Humira and Enbrel, covered under Part B. Tell the client to talk to her doc. Assuming G/D, you just saved her $3500 this year and $2K next year. If you put a person with a diagnosis requiring Humira on an MAPD, I got nothing. PAN Foundation?

Keep being a know it all, who is so green he didn't know how to use the search button on the forum to help save his client money. There's multiple threads on Humira/Infusion Alternative.

Y'all crack me up. Some of the most unhelpful, egotistical people I have ever had the misfortune of meeting online.

Also, you're wrong but I digress.

 

[rmhaire]

Some of the most unhelpful, egotistical people I have ever had the misfortune of meeting online.

Is it any different on the other side of the pond?

 

[somarco]

48 FDA approved #biosimilars . . .

Biosimilar Drug Information

This page includes a chart of the approved biosimilar and interchangeable products.

www.fda.gov

 

[rmhaire]

48 FDA approved #biosimilars . . .

Biosimilar Drug Information

This page includes a chart of the approved biosimilar and interchangeable products.

www.fda.gov

You expect me to read all that? I've got a better way.

If Mom says they do then dammit they do.

 

[kgmom219]

This is actually for the biosimilar subsitution rule that is going to be implemented on 1/1/25. But I need more time to read all 1500 pages.

The infusion option for Humira? 10 years ago? Its been a while.

 

[kgmom219]

Y'all crack me up. Some of the most unhelpful, egotistical people I have ever had the misfortune of meeting online.

Also, you're wrong but I digress.

1. I'm not wrong. If I post it, I am right. I don't comment if I am not 100% sure.
2. Due to *** agents like you, I've got the docs who prescribe Humira and Enbrel in DFW sending me clients, getting their patients the best coverage available. Over 65 and Under 65.
2. I won't speak for everyone else, but I've earned the ego. I was a broke single mom with 2 kids feeding 3 people on $50 a week when I started. Last week, I got the BCBSTX #1 Over 65 award. Again.