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How did you obtain BRINSUPRI?
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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@sarahlynn1960
By the way thank you so much for your comments! This forum is truly a blessing!
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1 ReactionIt is a Medicare Advantage Plan, however, I signed up over 25 years ago and grandfathered in a plan no longer offered. I have not looked this up but someone posted you pay the $1,500 limit and after that nothing. I'll see if I can find out what the Brinsupri cost is.
I have Cigna Medicare. My copay was $1740 per month for as long as I am on it. The specialty pharmacy called me and had me apply to the Assistance Fund. Once I was approved all costs are covered by them
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1 Reaction@sarahlynn1960 When my doctor asked me if I would like to go on Brinsupri he said let me know and I'll see if I can get it for you. So I presume in all cases the doctor has to go above and beyond to get the prescription covered by Medicare. I see him in December and I'll report what he tells me as I now feel I would like to try it but not at the listed price.
@drwholigan
Thank you! Is that an Advantage plan or? Is it a Cigna Part D prescription plan?
@irenea8
Cigna Part D Rx plan
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2 Reactions@irenea8
1740 per month? I thought with Part D you could not exceed 2100 a year? Is that not the case for specialty exception drugs?
@irenea8 I have Aetna plus United Health for D coverage. I asked who was paying for my Brinsupri and they said my insurance covered part of it and Pharmacy the rest….I’m also on Medicare. My copay is $10. Marilyn
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2 ReactionsThis is just a thought and if you've tried it, I missed it in comments.
The manufacturer's program called Insight. Website:
"To learn more about the support available for BRINSUPRI, call inLighten™ Patient Support at 833-LIGHT-00 (833-544-4800)."
Perhaps if you called with your list of possible providers, they could check to see which are paying.
@irenea8
That is not the case.
If the drug is not in the insurance company's formulary
the 2100 per year limit does not apply.
I would have had to continue to pay 1740 per month
for as long as I was on the drug. Or until the drug was
listed in my insurance company formulary.
Your doctor can contact your insurance company
and request that it be added to the formulary.
I don't know how well that works though
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