← Return to Actemra coverage on Medicare in California?
DiscussionActemra coverage on Medicare in California?
Polymyalgia Rheumatica (PMR) | Last Active: Sep 23 8:24am | Replies (28)Comment receiving replies
Replies to "It's very simple to find out which Medicare part D drug plans cover Actemra. Just go..."
"I believe that yearly part D drug costs will be capped at $2000 starting next year."
I hope this is the patient's "out of pocket cost" will be capped at $2,000 per year.
I once proposed the idea that the number of medications a patient could have should be capped at a 5 medication limit and no more than 5. It would be the patient's decision to decide which medications worked the best for them. If a new one came along that exceeded a 5 medication limit they would need to stop one before starting the new one. I thought things would be simpler that way. I said it as a joke but I think some people thought it was a serious proposal.
After I was diagnosed with PMR and started on prednisone, my medication list exploded to over ten medications. Some people said I was over my limit. After I started Actemra and discontinued prednisone my medication list went back down to 2 medications not counting my Actemra infusion. I said my Actemra infusion shouldn't be counted since my Actemra infusion was administered in a hospital setting. An infusion given in a "hospital setting" wasn't considered to be an outpatient prescription medication according to Medicare. This is true even though I go to the hospital to get the infusion for an hour and I go home after every infusion.
The whole problem with medication costs is about who is going to pay for them.
Sometimes I think people wouldn't need so many medications if they were only prescribed just a few that worked well and only the medications which didn't cause so many side effects.