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Effects of new drug pricing caps for medicare patients
In 2025, those of us on medicare have been promised a cap on our drug expenditures of $2000/year. This means that some of the very expensive medications like Tymlos, Forteo, could be significantly reduced in price to us. I am optimistic that this will happen but of course it may not . If it does though, the question is, how do we safely postpone until 2025 going on these much more expensive medications as i have read that the effects of Tymlos, Forteo are reduced if you take a bisphosphonate ahead of these in 2024.
So, what is a reasonable affordable sequencing?
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@serious I'm hoping the cap limit happens. I was diagnosed with osteoporosis in March of 2023, but couldn't see a rheumatologist until July. She told me about the possibility of the out of pocket limit at that time as she was prescribing Tymlos. Since Medicare deductibles ( I have an Advantage Plan) start over again every January, I decided to do some serious research on the drug options because Tymlos comes with some scary side effects. I got a second opinion, and they agreed that I should take Tymlos for 2 years. I decided to start in January 2024, so hopefully I will only be paying the outrageous deductibles twice. And if in January 2025 the cap does go into effect, the January deductible will cover the rest of the year for me at no further cost.
The 9 months between my diagnosis and starting Tymlos I upped my calcium intake by diet but didn't take any extra calcium supplements for very long. They do not sit well in my stomach. (I get enough through my regular diet anyway) I also already took a magnesium, K2 and D3 supplement, so continued with that. I use a collagen peptide powder daily. I didn't opt to take any bisphosphonates before the Tymlos, as I wanted to continue what I was doing. I'm 66, run, walk, hike, bike, work out with weights, do yoga, etc. I figured that the dexa score didn't happen overnight, so waiting to start when it financially made sense was OK. My lumbar score was a -3.6 one year ago this month. Good Luck!
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1 ReactionMy endocrinologist said the same thing. Taking biophosphates before taking Forteo reduces the effectiveness of Forteo. I don’t think I can wait until 2025 however.
If you have traditional Medicare + Part D RX coverage and decide to wait on an expensive drug until 2025, as plan changes are announced, be careful to confirm that the drug is not dropped from your plan's formulary for 2025.
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2 ReactionsWhen are the formularies for 2025 available to check? This sounds like good advice.
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1 Reaction@serious, Medicare says the next year formularies are available to the public after Oct 1. My experience is the insurance carriers continue to tweek the formularies up to, and sometimes beyond, Jan 1. It's a moving target.
Does the $2000 cap to customer drug expenses for next year only apply to drugs in your Part D or Medicare Advantge formulary? This would certainly be a way to control costs but could be not so good for customers.