Request for assistance with cost of Kisqali denied: How to reapply?

Hi @mossa
I have been receiving financial assistance for Kisqali from the Novartis PANO program for over a year since I went on Medicare. I just received a letter stating that due to a variety of changes in government regulations the manufacturer is lowering the income threshold by $20k for 2025 so I will no longer qualify. That’s the bad news. The good news is in 2023 my annual copay without assistance would have been $14k. In 2024 $8k. In 2025 the out of pocket limit for covered drugs will be $2k annually and that includes all the covered drugs you are taking. So I’m losing financial assistance but the copay will be more affordable — still ouch. I just hope in 2025 Kisqali is still covered under Medicare. It should be. I have original Medicare and the part D drug plan but I believe the $2000 annual limit is for all Medicare drug plans.

My oncology office helped me apply for the assistance. Be sure to check why you didn’t qualify and who you applied to. If it’s because of income that’s one thing but if it was for some other reason maybe your oncology office can help you re-apply.

I hope you have better luck with Kisqali. I had to lower my dose once but my body overreacts to most meds. I have been taking it for 3.5 years now and will continue indefinitely so long as it is effective. Blessings to you.

Thank you so much! I was able to contact Novartis today and spoke with nurse practitioner at onco office so hopefully can get the ball rolling. Best wishes to you!!

Hi @mossa
I have been receiving financial assistance for Kisqali from the Novartis PANO program for over a year since I went on Medicare. I just received a letter stating that due to a variety of changes in government regulations the manufacturer is lowering the income threshold by $20k for 2025 so I will no longer qualify. That’s the bad news. The good news is in 2023 my annual copay without assistance would have been $14k. In 2024 $8k. In 2025 the out of pocket limit for covered drugs will be $2k annually and that includes all the covered drugs you are taking. So I’m losing financial assistance but the copay will be more affordable — still ouch. I just hope in 2025 Kisqali is still covered under Medicare. It should be. I have original Medicare and the part D drug plan but I believe the $2000 annual limit is for all Medicare drug plans.

My oncology office helped me apply for the assistance. Be sure to check why you didn’t qualify and who you applied to. If it’s because of income that’s one thing but if it was for some other reason maybe your oncology office can help you re-apply.

I hope you have better luck with Kisqali. I had to lower my dose once but my body overreacts to most meds. I have been taking it for 3.5 years now and will continue indefinitely so long as it is effective. Blessings to you.

This is great news for both of us! I am in your boat (also got the letter), and I so appreciate the research you have done. I have read that Medicare will cover it. Thank you!