Medicare Plan D for someone with NTMs

@paxmundi whoooooooooohooooooooooooooooo!!!!!!!!!!

Each state has its list of Part D providers available. I am in Delaware. In reviewing the formulary lists and costs the best 2 companies I see are HealthSpring (previously Cigna) and WellCare. I looked at drugs for pseudomonas, MAC and some of the drugs to treat Abscessus. HealthSpring seems to cover Nuzyra (for Abscesses) WellCare doesn't cover that drug.

This is very helpful. Thank you for your kind response.

All the best to you.

Aida

Me too. Had BCBS BlueMedicare Premier HMO. Got letter saying my plan was being discontinued. They also included papers to prove I have legal"right to issue" because my plan is being discontinued due to no fault of my own. Ive spent the last week looking and trying to find someone not trying to sell me a plan just to get help deciding on one! Heck I even left messages at Insurance broker sites a week ago. No one calling me back. It is so frustrating that our health are system is run by big money and big pharma. I remember the day when I worked in medical clinics and hospitals where drs closets were bursting at the seams with samples and even when I was the patient my dr would just hand me however many doses I needed and pat me on the back. I haven't had a dr offer me samples in probably 20 years.

I think I am going with Healthspring. Im worn out worrying about it! And I haven't even started treatment for my MAC diagnosis!

@lulu1944 A person at Medicare.gov was very helpful today. Now I know that to check the formularies for Part D plans I need to know the dosages of the drugs, the quantity and the frequency of the prescription. That is another small research project since I am not presently taking any meds.

@sherrig I just went on medicare.gov to compare drug costs for all local Medicare Advantage plans and the lowest annual out of pocket for Nuzyra was about $170,000 (maybe it was $117 K but pretty sure it was the higher). So, though it is covered, it doesn't really matter due to the copay (at least for me here in AZ). For Abscessus there is another problem: I was diagnosed with MABC and my insurance denied coverage for Nuzyra since it was not FDA approved for Abscessus or yet considered "recommended" treatment. So, for some NTM's, it's covered but not abscessus. My local ID wrote 3 appeals, but all were denied on the grounds that it is not recommended treatment. This was about 5 months ago.

So sorry to hear that!

@sherrig I went back and double checked, sure enough Healthspring had $2100 annual cost for Nuzyra. Humana listed $234,000-yikes. Good to know. Thank you! Brinsupri didn't come up.

@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.

@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. 🙂