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insurance coverage for Arikayce
Did anyone succeed in having their health insurance cover Arikayce WITHOUT having a positive sputum sample six months after starting meds? Is producing a positive sputum sample after commencing antibiotic treatment the only way to get insurance to cover Arikayce?
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@kathyjjb Congrats on testing negative!
Did your insurance state why they denied it?
@six5532one
My pulmonologist's nurse liaison handled all the details I just filled out the application so I'm sorry I can't answer your question about insurance approval. Perhaps you can contact The assistance fund yourself. tafcares.org Good luck.
Jean
@six5532one
Sorry, I had a memory blip-it wasn't the Arikayce that was denied, it was Nuzyra. The Arokayce would have been changed from daily Arikayce to IV Amikacin 3 times per week due to me losing my voice. I could not talk at all. I think if I was ok on the Arikayce that too would have gone from 7 days per week to 3. I'm so glad I saw Dr Haas at NJH, she was really focused in getting my doses down. They also tested told me that I could cut my Linezolid dose in half after metabolic testing.
Thank you! Just hoping the negatives stay negative. MABC has a 50% recurrence rate, so I'm cautiously optimistic.
@six5532one
I was only on antibiotics for 3 weeks, fortunately my NJH visit was scheduled shortly after I started. If MABC returns, I will go on inhaled IV Amakacin, Linezolid, and Clofazimine (I think that was the 3rd one). Keeping fingers crossed.
I have standard Medicare (NOT Medicare Advantage) with Part D coverage. AARP/United Heath Care.
The government said that for 2025, I am limited to $2,000 max for the year. So after my Arikayce in
February, ALL of my prescriptions have been zero. But next year my part D is going from $285/month
to $340/month.
Harry
@harrynsc Considering the savings that the max out of pocket is this year...and hopefully next year....the approximate $55.00 increase is minimal. Your drug plan alone is $285 or is that your entire Medicare Plan? From my understanding of what you said you just have Original Medicare and a D Drug plan. No Medical Supplement Plan/Medigap Plan???
Barbara
@blm1007blm1007
The $285 is per month for AARP/UHC supplemental and part D.
@harrynsc Thanks for the full detail.....I like the sound of that better.
Barbara
I have been on IV meds for 12 weeks next week. My pulmonologist is taking me off my three meds. She is placing me on clofazamine, linezolid and Arikayce. I called the local Air Force Base pharmacy since we are covered by TRICARE for life. The ARIKAYCE will require prior authorization due to its excessive cost. We do have Medicare A&B. No Part D Thoughts?