Brinsupri (aka Brensocatib)

Yes, me too, on the chronic upper respiratory infections. If brinsupri -aka- brensocatib is supposed to help with exacerbations but a common adverse reaction is upper respiratory infection, then seems to me it is simliar to the Big 3 meds when I was on them for MAC: Do the side effects or adverse reactions make it worth taking? Do the benefits outweigh the disadvantages?

All side effects from any drug are concerning. If you experience do experience a side effect that is a problem, then you have the choice to stop taking that drug. Otherwise you don't know unless you try.

I am in the same boat. No part D yet. I think without any assistance it will cost over $7000 a month! Does anyone know at this point which Part D plan will cover Brinsupri? Or if you were prescribed Brinsupri and it was covered can you share which plan you are on?

From my understanding, the way to figure out what it costs you is to get a prescription, fill out the inlighten forms. From there a rep will contact you and discuss payment and payment plans, which they have in place.

Hi Irene - No one can answer your question about which Part D plan will cover Brinsupri at this point. It is not yet on the formularies, and won't be added until they do the new ones for 2026.

Even then, most new, specialty drugs don't show up there - they are covered by "exception" - you need to go through an approval process.

This is what I mean - I have what many docs describe as a "golden" plan - Medicare Primary backed by my former employer's Blue Cross Blue Shield as secondary coverage (We pay $7000/year in premiums + Medicare B premiums for this.) Even they make us jump through hoops for every biologic and most newer proprietary (name brand) drugs. But I feel fortunate - once we get approved, our drug costs are "capped" by Part D at $2000 each - our copays get us there by November.

What I suggest is to contact Insmed to find out which companies have been most proactive in working with them.

Thanks Sue. I know so little about Part D and where to start. So when you say contact Insmed to find out which companies do you mean which insurance might best cover it under part D? Who do you go through the approval process with for the exception? Your Part D insurer? I would not want to sign up for a plan only to find it did not cover the one drug I may end up trying. I would want to know in advance but is that possible?? I may not be making sense but like I said I know little about part D.

It's more like which part D and in which state. I've been on part d for 2 years, moved states last year and very disappointed in coverages for the tier 3, 4 and 5's we need

what is tier 3 etc?

Level or Tier 1: Preferred, low-cost generic drugs
Level or Tier 2: Nonpreferred and low-cost generic drugs
Level or Tier 3: Preferred brand-name and some higher-cost generic drugs
Level or Tier 4: Nonpreferred brand-name drugs and some nonpreferred, highest-cost generic drugs
Level or Tier 5: Highest-cost drugs including most specialty medications

If the drug is listed with a tier in your plan, it is not covered. Sometimes an appeal can get coverage. An organization like NJH has a better chance of getting an appeal approved.

I think you meant to say if a drug is NOT listed? Even then , Tier 4 & 5 drug approvals are a "crap shoot" for us, depending on who is the Pharmacy Benefit Manager (PMB). This year we were fortunately able to switch away from the plan that gave us endless grief last year, even on some Tier 3 medications. Last year I spent over 150 hours on prior approvals, appeals, and more for Tier 3 & 4 medications, this year maybe 20 hours?

Another thing about formularies - the listing is not the "whole story" each medication may also have codes which indicate limits on dispensing, whether "step up" therapy is required (trying other cheaper meds first), and whether prior approval is required.

@irenea8 If I was starting this process, I would look for an independent (not tied to one insurance provider) Medicare consultant to walk me through this.