How did you obtain BRINSUPRI?

Posted by irenea8 @irenea8, Oct 22 8:25am

It seems many on this forum are taking Brinsupri. Assuming you are on Medicare I would really appreciate hearing how you got it approved. I know it currently requires a PA (prior authorization from your Dr). So the question is which Insurance approved it? Which Part D plan?
I never signed up for Part D so I must do that NOW so that my Dr can submit a PA to them. Brinsupri is not on any formulary lists and doubtful that it will be in 2026. So selecting a Part D plan in hopes that they will approve it, is just a gamble. In my area I have Wellcare, Silver Script, Humana, Medicare Blue and Health Spring (used to be Cigna) to choose from. Did you have success with any of those?
One person suggested that they “have to approve it” if a PA is submitted and there are no other choices etc. but I have learned that is not true.
My Dr really wants me to try it for my serious situation. Any insight would be greatly appreciated.

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kathyjjb | @kathyjjb | Oct 23 1:29pm

In reply to @irenea8 "If you have gotten Brinsupri through a part D plan please tell me which plan that..." + (show)

@irenea8 I'm looking for the same thing, preferably a medicare advantage plan that has a low copay for brinsupri.

irenea8 | @irenea8 | Oct 23 2:37pm

In reply to @sarahlynn1960 "I just saw this on another site" + (show)

@sarahlynn1960
Thanks Sarah. Yes this is all accurate and I understand. Brinsupri is not on any formularies and as such you can only get it by an exception in which your Dr submits a PA to your prescription drug plan. The prescription drug plan can either approve it or not approve it. So since I do not have a Part D prescription drug plan as yet, my Dr cannot submit the PA for Brinsupri. I want to sign up for a Part D plan that might give me the best chance of getting it approved. Hope this all makes sense. I would be happy to explain more if I can. Thanks for your help.

irenea8 | @irenea8 | Oct 23 2:40pm

In reply to @sarahlynn1960 "Why does this site keep making me sign in every time I click to reply?! Anyway,..." + (show)

@sarahlynn1960
Sarah do you have a prescription drug plan already or do you need to get one like me?

sherrig | @sherrig | Oct 23 3:05pm

I'm in Delaware with the exact same part D offerings. Not on any formulary.

sarahlynn1960 | @sarahlynn1960 | Oct 23 3:52pm

In reply to @irenea8 "@sarahlynn1960 Sarah do you have a prescription drug plan already or do you need to get..." + (show)

@irenea8

sarahlynn1960 | @sarahlynn1960 | Oct 23 4:05pm

Thanks! I do have a drug plan: WellCare. My part d is bcbs NC

sarahlynn1960 | @sarahlynn1960 | Oct 23 4:07pm

I hope someone who has gotten it will comment, so we’ll know who might cover it

irenea8 | @irenea8 | Oct 23 4:21pm

In reply to @sarahlynn1960 "Thanks! I do have a drug plan: WellCare. My part d is bcbs NC" + (show)

@sarahlynn1960
If you already have a part D drug plan then you need to ask your Pulmonologist if he would prescribe Brinsupri to you. If so, he would need to submit a PA (prior authorization for an exception drug) to your prescription drug plan. Then they would hopefully approve it. Has your Dr prescribed it to you? If so he or she should have known about this.

sarahlynn1960 | @sarahlynn1960 | Oct 23 5:40pm

In reply to @irenea8 "@sarahlynn1960 If you already have a part D drug plan then you need to ask your..." + (show)

@irenea8
No, I just sent him a message about it today, because previously I hadn’t decided whether to pursue it yet. I don’t even know if I’m eligible.