@cynthiaefs Actually, insurance is covering many biologics, with strict limits and prior authorization. In my opinion, while frustrating to me as a patient, this is appropriate for a number of reasons.

First, biologics were developed for those situations where the "old standby" treatments don't work. So if an older, cheaper drug works, let's use it to help keep costs down.

Second, many biologics (and other new drugs) have limited data to show their effectiveness and safety over time when prescribed in the "real world" (clinical trials have a limited patient base & short time.)

Finally, if I take one biologic drug at a cost of $10,000-$15,000 per year, that effectively wipes out my entire insurance premium for the year. Someone else (other insureds, the insurance company, the government) is then on the hook for all of my other medical costs - office calls, lab tests, hospitalizations, PT, etc...No wonder medical costs are spinning out of control.

@cynthiaefs
This is to everyone on Medicare. The federal government sets a limit on how much we can be charged for prescriptions that are covered (this means on the formulary) by your drug insurance. This year it is $2100. It doesn’t matter how many prescriptions you have. If you have one or a dozen the cap on the entire set is $2100 (if your insurance covers them). So check every open enrollment season to make sure your insurance covers the drugs you need.