Brinsupri (aka Brensocatib)

@lindabreathless
Irene, ironically I just received notice that Cigna is not offering a prescription plan any longer after Jan. 1st. I understand that they merged with another company and will be called HealthSpring, but they are not available in my area of Florida. There number is 855-401-9625 if you want to check your area for them. I’m working on finding a new plan.
Best of luck…

@lindabreathless
I read an article stating that some major insurers are scaling back advantage and part D plans fro 2026 and some people might lose their coverage if it is dropped in certain areas of the country. These changes are a response to financial pressures, including changes to government funding and rising healthcare costs. This has led insurance carriers to scale back their offerings in less profitable regions. I wonder if they will also scale back coverage of specialty drugs as well as dropping locations. Probably will.

Is there anyone on the forum that lives in Iowa, received Brinsupri and is on Medicare? If so I would love to hear which plan D allowed you to get it through the exception process.

@lindabreathless
I read an article stating that some major insurers are scaling back advantage and part D plans fro 2026 and some people might lose their coverage if it is dropped in certain areas of the country. These changes are a response to financial pressures, including changes to government funding and rising healthcare costs. This has led insurance carriers to scale back their offerings in less profitable regions. I wonder if they will also scale back coverage of specialty drugs as well as dropping locations. Probably will.

@irenea8 just found this post from you by accident ... I am on Humira which treats a couple of autoimmune conditions. It is a specialty drug. It has kept me in remission for 7+ years. Just got a notice from my Aetna Medicare Advantage plan that they are taking it off their formulary for 2026 and suggesting we work with our doctors to transition to the "biosimilar" which came on the market a couple years ago at a fraction of the price. Humira is phenomenally expensive and I think I read it's one of the most profitable drugs in the world. My GI doctor's office had warned me that a lot of insurances are no longer covering it in 2026. So that's a long way of saying that yes, specialty drugs are being cut back. At least this one (Humira).

@lvnl Here is a different viewpoint to consider.

Insurers and Medicare need to control costs when and where possible to avoid more premium increases. I know many people insurance companies believe are rich and can afford everything, but when I think about what my medical care and prescriptions cost, the $10,000 I pay in premiums and the $10,000 or so my employer contributes don't begin to cover the costs of my husband's & my care, even with the discounts the pharmacy benefit managers negotiate, and the limits Medicare places on charges.

Whenever there are generic or bio-equvalent drugs available we willingly try them. Nearly all have been fine and have saved both me and the company money. If they do not work after a reasonable trial, Blue Cross has made exceptions after sufficient documentation.

Similarly, when I wanted a faster nebulizer for my convenience, I didn't expect my insurance company to cover it. But, if I NEED it to dispense a specific drug, I'll fight for it.

Expensive specialty drugs like Brinsupri will need to demonstrate to insurers that they reduce primary medical expenses (like hospitalizations) in order to get onto their formularies or continue be covered.

@lvnl Here is a different viewpoint to consider.

Insurers and Medicare need to control costs when and where possible to avoid more premium increases. I know many people insurance companies believe are rich and can afford everything, but when I think about what my medical care and prescriptions cost, the $10,000 I pay in premiums and the $10,000 or so my employer contributes don't begin to cover the costs of my husband's & my care, even with the discounts the pharmacy benefit managers negotiate, and the limits Medicare places on charges.

Whenever there are generic or bio-equvalent drugs available we willingly try them. Nearly all have been fine and have saved both me and the company money. If they do not work after a reasonable trial, Blue Cross has made exceptions after sufficient documentation.

Similarly, when I wanted a faster nebulizer for my convenience, I didn't expect my insurance company to cover it. But, if I NEED it to dispense a specific drug, I'll fight for it.

Expensive specialty drugs like Brinsupri will need to demonstrate to insurers that they reduce primary medical expenses (like hospitalizations) in order to get onto their formularies or continue be covered.

@sueinmn Would there be consideration for prevention - for the long term advantages of a drug like Brinsupri that reduces inflammation for those with worsening or more severe BE disease, and would presumably reduce risk of hospitalization or more urgent intensive care and other costly antibiotics for patients in the future?

Drug costs are high. It’s a bit shocking to hear the cost of a drug plan in the United States though, relative to other westernized countries.