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Actemra coverage on Medicare in California?
Polymyalgia Rheumatica (PMR) | Last Active: Sep 23 8:24am | Replies (28)Comment receiving replies
It's very simple to find out which Medicare part D drug plans cover Actemra. Just go on Medicare.gov, enter your medication list, and it will tell you which plan will give you the best coverage and what it will cost. At the end of last year, before I got on Kevzara, I just entered that medication and found out the best plan and what my co-pay would be for that drug. It was $300 per month. I applied for patient assistance through the drug company and get it for free but I have to reapply at the end of the year. I believe that yearly part D drug costs will be capped at $2000 starting next year.
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"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.