@boomermeg I have a Medicare Advantage plan, and I take Actemra. I'm currently taking 2 injections per month, but I took 4 injections per month for 2 years. I get a monthly report online and also through the mail about my drug costs. Here are the numbers for a month where I was taking 4 injections:

Drug price charged by the specialty pharmacy: $4876
Discount from manufacturer: 975
Amount pain by insurance: 3901

Because I am taking injections, the Actemra is covered by Part D. There is a maximum of $2100 out-of-pocket for Part D medications for 2026. I think the maximum will be $2200 in 2027. I paid the full $2100 with my first refill this year, but I think you can set it up so that the copay is evenly distributed over the year. For this year, that would be $175 per month, and next year $183 per month. If you started taking Kevzara now, in September, you would have to pay the full $2100 in 4 months, so that would be more. That assumes you haven't already paid part of the $2100 for other prescriptions. Then in January, you could start paying the $183 per month if you set it up that way. For me, paying the full out-of-pocket copay at the start of the year is a big hit, but from then on all of my medications for the rest of the year are no cost to me.