Curious how you are paying for meds

I am curious how those in the US that are retired and on Medicare Part D are paying for meds.

Since i Just retired, I am trying to figure all this out. Right now, I have moved unto my wife’s commercial insurance since she is still working. It is covering my RINVOQ either directly or via co-pay card. Looking at what my meds will cost under Part D when that day comes, I will not be able to afford them.

The RINVOQ would cost me over $1,900 month. Any of the biologics are 1 or 2 thousand a month under part D.

My patch for pain control would be right at $300 a month.

Several of my other meds are at $1,000 a month.

How are any of you that are in the US affording your meds if you are on Medicare?

You will reach your catastrophic coverage Within the first month if you are paying for biologics on part d. I take skyrizi which is $20,000 per shot which puts me immediately into catastrophic coverage making the rest of my medications free for the year. I don’t have to pay the $20,000. Obviously I only pay my co-pay for part d . Make sure that your doctor requests a formulary override if your medication is not on your insurance formulary.

What do you have that is covering it?

I chose Humana for part d.

What do they pay for your bilogics, if I may ask.

They pay for all of it after I pay my deductible and copay. The first month of the year is really rough because I have to meet all of the deductibles and things. I needed a pre-authorization for the skyrizi but once I was approved they had no trouble paying for it.

Just my Rinvoq would be $1,900 a month until I hot the. I have $4,000 of other meds, so I would max it out the first month or part of the second one. I don’t have that kind of money now.

I was on Humira and Tremfya. I am going to start Cosentyx. I am on a Medicare advantage plan which have very high copays for these biologics. I have learned that the pharmaceutical companies have patient assistance programs. I have met their financial criteria and I got Humira and Tremfya without a copay. You can check- out the financial criteria on the company’s patient assistance websites. Hopefully, you meet their criteria.

I may need to do that when my wife retires. I moved to her insurance so I can still use the Co-Pay cards for now. However, the biologics have done so little for me, I am not sure they would be worth paying for at any level.

Humira and Tremfya didn’t work. I am going to start Cosentyx. Hoping 3 is the charm. I am dealing with enthesitis. Hope things work out for you.

From @Vic

I was told by my rheumatologist that pharmaceutical companies that make the biologics have patient assistance programs. Humira is through AbbVie. Tremfya is through Jannsen. Cosentyx is through Novartis. My doctor first submitted the prescription to my primary Medicare Advantage insurance which is OptumRx. They approved but the copays are exorbitant. This allowed me to then pursue the pharmaceutical companies. The pharmaceutical companies have forms and financial statements to fill out and submit. My rheumatologist’s staff helped with the forms. I have met their financial requirements and have gotten the Humira and Tremfya with no cost to me. I am still waiting on Novartis.

I feel the financial requirements are fair. I wouldn’t be able to take these biologics without this assistance and I am very grateful for this. I hope this helps.