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Starting Arikayce - nervous

MAC & Bronchiectasis | Last Active: Apr 15 10:36pm | Replies (120)

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@kathyjjb

I have a Medicare supplement plan and have heard that some insurance companies have high co pays and possibly some won't pay for Arikayce. What is your experience? I called my insurance company and I was told it wasn't on their drug list. Hopefully, the customer service agent was just referring to drugs sold at pharmacies.

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Replies to "I have a Medicare supplement plan and have heard that some insurance companies have high co..."

Every year at open enrollment I look and check to be sure the plan I have and/or am considering for the coming year will cover the medications that I might possibly need, as well as the pharmacies (in my case, Vanderbilt Specialty Pharmacy). I had to change drug plans to get Arikayce in my formulary, but it was before I was on it.

With the catastrophic coverage cap at $2000, as long as the drug is in the formulary, that will be the maximum you will pay per year for all medications out of pocket. I know that's still not chump change, but when I was on it Arikayce you paid 5% with no max and if I hadn't qualified for The Assistance Fund, my out of pocket would have been around $13K as I recall. If you do go on it, your provider should be able to help you see if you qualify for assistance.

But yes, every year, check and see what's in the formulary when you use the online tool in Medicare. It's my understanding -- but I'm not an expert or professional -- that if a drug is in the formulary when you sign up and you're on it, even if they drop it midyear you will still be covered. But again, I'm not 100% on that.

Good luck!
Laurel