Nuzyra (Omadacycline)

Thank you for sharing this. Even if no one else is impacted now, someone might be in a week or month and can find your helpful post.
I hope it's working and you're feeling better!

I have looked at the Medicare Advantage Plans and only Healthspring Medicare Advantage covered Nuzyra and didn't have a $200K annual copay like the others. I called Healthspring and NJH was out of network. I have gone to NJH twice this year and they did have other options. I really don't want to lose NJH as my specialist, since they are lightyears ahead of my local ID and pulm, with respect to MABC. My MABC cleared spontaneously from the cultures but not sure if that really means it's gone since recurrence/reinfection is 50% with MABC.

@kathyjj I’m not up on a lot of the Medicare info yet so I’m sorry to sound so ignorant, but you’re saying that to get meds covered the drug plans, the drs office has to be connected to the drug company? I thought it only had to be connected to the actual insurance company (part d), but could go thru whatever drugs the drug company covered in their formulary

@sarahlynn1960 actually I see you’re talking abt advantage, but does anyone know if the same applies to part d and the drug plans?

@sarahlynn1960 Sorry for the misunderstanding. What I'm saying is that it appears Healthspring was the only insurance company that didn't post a $200,000 annual out of pocket for Nuzyra. And, I probably won't go with Healthspring since NJH is not an in network facility/drs. NJH did tell me there were other drug alternatives for MABC.

To all -Prescription coverage (Part D) in Delaware (each state is different) the 2026 formulary for HealthSpring EXTRA Plan lists Nuzyra in the formulary, so if that doesn't change the total out of pocket should be capped at the $2,100.00 for the year. However, the HealthSpring ASSURANCE plan DOES NOT list Nuzyra in the formulary, so if that plan did approve by exception, the $2,100.00 out of pocket cap would not apply.

I am not familiar with NJH pharmacies, maybe NJH would be able to send a script to a different pharmacy that is on the HealthSpring Extra pharmacy list.

I go to Johns Hopkins and I get some of my medications from their pharmacies and others at my local pharmacies. They don't require, but it can be more convenient, that I use their pharmacies for my treatment medications.

@sherrig I wasn't talking about the pharmacy. I am merely saying that NJH CINICS and DOCTORS are not in network with any Healthspring plan. So, I probably won't go with any of Healthspring plans despite the fact that it's the only Medicare Adv plan that has Nuzyra in the formulary.

Gotcha! Thanks!

I am not on Medicare yet and have Aetna as my insurance provider. They are shockingly paying all but $100 a month for it. Even my ID Dr was surprised and happy. I’m so thankful you said you have had no side effects from it. I’ve been on for two months, and it seems like so far so good.

I remembered my third med: Amikacin, and it was the one delivered via IV pump ball. The Omadacycline and Linezolid were pills.