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Medicare Plan D for someone with NTMs
MAC & Bronchiectasis | Last Active: Oct 29 3:36pm | Replies (14)Comment receiving replies
@kathyjjb Keep in mind that Medicare caps your out-of-pocket costs for Plan D. What is more important is what is included in their Formulary (list of covered drugs). Any "uncovered (unlisted) medication requires an appeal. We have found that the PBM Plan provider (Pharmacy Benefit Manager) is more important in success than the Plan - BCBS and CVS have been easier for us to deal with than United Health - we are in Minnesota.
Replies to "@kathyjjb Keep in mind that Medicare caps your out-of-pocket costs for Plan D. What is more..."
@sueinmn Thank you! I'm going to talk to a BPM after I identify the pharmacies that carry Brinsupri. Great idea! I do understand the $2100 cap is for those listed in respective Formulary. Unfortunately, the drugs that I was most interested were either not in the Formulary or not considered a standard treatment drug for MABC. As I previously mentioned, this was an issue with Nuzyra and still denied after 3 appeals. My ID doctor told me that this was pretty std and recommended another medication. Fortunately, I don't need at present but just want to plan ahead-just in case.
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@sueinmn Thank you, Sue! I didn’t even know a Pharmacy Benefit Manager was a thing. I will have to research. Without being on meds yet I don’t know doses or quantities or frequency—all of which is part of the analysis. More research on that too! My lungs’ inability to process the mucus produced by much food without triggering hemoptysis has me down to 86 and now 87 pounds though I had three days of 88. Still active as can be, which may be part of the problem—not resting enough. Very much appreciate your input on this. 🙂