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For those on Medicare
#280606 06/22/18 12:57 AM
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seven86 Offline OP
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What do you do about biologics? I'm now on Medicare. I'm on Simponi, but with Medicare, my Simponi One cost support no longer applies. My co-pay for a 3 month supply would now be $2800.

Simponi Aria infusions would be $1300/infusion.

Anyone who is on Medicare and biologics, what do you do?

Re: For those on Medicare
seven86 #280607 06/22/18 12:26 PM
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Would that copay apply all year or just until you emerge from the so-called "donut hole"? Note that I'm not personally affected yet, but my mother is. She is able to manipulate her retirement income such that she qualifies for a different drug manufacturer assistance program for people on government insurance. It is an income-based program, as she has to send them copies of her tax return each year.

Re: For those on Medicare
seven86 #280611 06/22/18 03:08 PM
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Have you called Simponi's patient support hotline? Their program is called Janssen CarePath and the number is 877-CarePath (877-227-3728)

Do you have a Medicare supplement plan?

Questions about Medicare come up from time to time, so use the Search feature to see what you can find. Here are a couple of threads I found. I don't know if they will be helpful or not.
http://forums.spondylitis.org/ubbthreads.php?ubb=showflat&Number=272183&page=1
http://forums.spondylitis.org/ubbthreads.php?ubb=showflat&Number=271478&page=1


Ginny - 58 year old female
Dx with USpA in March 2013; changed to AS in July 2015
Iritis and Scleritis, both currently in remission
unicompartmental knee replacements: right-June 2014, left-Aug 2018
MTX, Humira, Cyclobenzaprine, plus Celebrex as needed
Supplements: Folic Acid, Vitamin A, Vitamin D, Calcium, Fish Oil, Culturelle probiotic, Melatonin (as needed)
Re: For those on Medicare
seven86 #280614 06/22/18 05:44 PM
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seven86 Offline OP
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Thanks for the info everyone!

Re: For those on Medicare
seven86 #280615 06/22/18 06:08 PM
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I went through this with Enbrel last year.

The website Needy Meds is a bit confusing to use, but its pretty good at finding discount and copay assistance programs for many medications and diseases. I entered Simponi and it pulled this up - http://www.needymeds.org/brand-drug/name/Simponi -- if you scroll down, it lists a phone number for people with Medicare to call. It appears there may be a program that provides assistance, dependent on meeting financial criteria.

Re: For those on Medicare
seven86 #280624 06/23/18 04:26 PM
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The crazy thing is, all the special funds have this agreement NOT to cover Medicare. Also the Gov doesn't try to buy in bulk for discount. So UNFAIR!!!!!


OK, I get the BEST supplimental it is maybe $30 more than the cheaper ones, but covers so much. I have no co pays at any doctors office. Since I see a lot of doctors, all specialists, that saves that monthy fee right away.

As far as the meds go, they completely cover the IV infusion meds but NOT the injections. So UNFAIR!!! I have been on Actemra for 8 years, put me in the best remission but darn, monthly IVs, sigh so disruptive. The same med via injection is $300 a month.

Anna


Actema IV once a month (with pre loading for allergic reaction), Cymbalta x1 daily, Arava 20mg daily. Diagnosed with AS in 2004, suffered undiagnosed since 1982.
Re: For those on Medicare
Banana #280626 06/25/18 01:00 AM
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Originally Posted by Banana
The crazy thing is, all the special funds have this agreement NOT to cover Medicare. Also the Gov doesn't try to buy in bulk for discount. So UNFAIR!!!!!


Actually, the pharmaceutical manufacturers DON'T have an agreement with the federal government not to cover Medicare patients. The Center for Medicare and Medicaid services enacted rules that forbid copay assistance coverage for a medication paid for by Medicare. Several pharmacy insurance plans have recently enacted similar rules. It is part of the effort to bring down the cost of health care. The theory is that if a drug costs significantly more, many patients will try cheaper medications first.


Not Me Too!
Re: For those on Medicare
seven86 #280644 06/26/18 04:20 PM
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But the Fed gov won't allow bulk buying.

The point is, i have never seen any program that covers Medicare and I wish people would only post who are ON medicare.


Anyway, all the IVs are covered so switch to an IV

Anna


Actema IV once a month (with pre loading for allergic reaction), Cymbalta x1 daily, Arava 20mg daily. Diagnosed with AS in 2004, suffered undiagnosed since 1982.

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