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Need To Understand How And If Medicare Covers Specialty Drugs

A MyPsoriasisTeam Member asked a question 💭
Sebastian, FL

What are the best Medicare Part D drug plans for our psoriasis/psoriatic arthritis specialty meds and also best medicare supplement plans (medigap?)

July 22, 2018
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A MyPsoriasisTeam Member

Every insurer is different and there is a large difference in medications covered under Medicare Advantage and Medicare A & B
Doctors are pushing through medications under Part B if available as infusions (but patient beware you are responsible for 40% out of pocket)
Make sure your insurer know all health conditions and why you take or do not take certain medications.
Certain medical conditions will get you more benefits; under my plan they are RA, heart disease, high blood pressure, diabetes.
Certain financial conditions will get you more benefits; under my plan they are behind in rent or mortgage, behind in utility bills; usage of food stamps/banks.
Patients AND doctors have to right to ask for exception for denial of medication.
Make doctors and insurance know other medical conditions and drugss (for instance I had to tell a dermatologist that Methotrexate reacted with Phenytoin.

September 3, 2023
A MyPsoriasisTeam Member

I have Humana and they do good on biologic Cosentyx

October 1, 2018
A MyPsoriasisTeam Member

My husband carries my insurance at work. We are wondering what happens when or if he can retire! My infusion is around 18,000 dollars each month for 1 treatment!

July 30, 2018
A MyPsoriasisTeam Member

Whoops, that was supposed to be any biologic that is done by infusion is covered 100% as long as you have supplemental insurance which mine is United Healthcare, through AARP and they did cover the one infusion of Remicade that I had. I had no out-of-pocket cost.

October 20, 2023
A MyPsoriasisTeam Member

I also have United Healthcare, as a supplement to my Medicare plan I am not on Medicare advantage. My rheumatologist told me that any biologic that isn’t infusion would be covered 100% because you do it in a doctors office so it comes under I believe it’s part A
As far as I know cosentyx is only available as an injection and yes, that will move your part D immediately into catastrophic,
My Rheumatologist told me they are getting ready to provide it as an infusion and that is the one he wants me to take but I’m still not sure I’m going to do it? As I said, previously breathing is rather important to me.

October 20, 2023

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