Need some info on Medicare - my BIL says my MIL is on a prescription that costs her $1600 a month.

[hedgehog]

Now, I don't know what she's on. It's possible she's getting something experimental or an off-label prescription. But does this co-pay sound possible?

[madokie]

1. 50+ bucks a day

Methinks someone is fudging the numbers a tad

[hedgehog]

7. I can believe the medication costs that much, but I'm trying to find out if

anyone has ever heard of a co-pay that high.

[mysuzuki2]

2. Possibly. Neither Medicare Parts A or B cover prescriptions.

Prescription coverage is available under the various part D plans. Does she have a Part D plan? There are many plans available. They all have different formularies. We are now in the open season for choosing or changing a plan. You and she can get on the internet and go to medicare.gov. There is a link there that allows you to enter your location and the names of drugs she is taking. It will then bring up the available plans which cover those medications. She should give it a try. No guaratees but she might find a plan which will lower her costs considerably. Do it soon however.

[Downwinder]

3. Is $1,600 the copay?

There are many that cost over $1,500 per month. Does she have Part D?

[hedgehog]

5. I'm getting the info third hand, so I don't have details, but the word I'm getting

is that the co-pay is $1600 a month. The problem is she isn't making platelets, so as near as I can figure out, either she should be getting steroids, which would be very cheap, or else she is on something very new that may not be listed on any of the formularies.
For all I know, she may be in the donut hole just now and it jsut happened to cost $1600 this month!

It's very frustrating, because the window for changing Medicare Part D plans closed two days ago!

[Downwinder]

8. Too many ins and outs. If she receives extra help the window

never loses. Some manufacturers offer a fee waived supply based on need. At that cost she will blow through the donut hole in a hurry.

[Roselma]

4. If she has opted for Medicare Part D, she should

see this: www.medicare.gov/publications/pubs/pdf/10050.pdf
(start at page 84)

[hedgehog]

6. Thanks - I've sent that info on to my husband so he can send it to his brother.

[Name removed]

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[Sgent]

10. Have her apply for Medicaid if she's eligible

that will cover the donut hole or co-pays.

[kestrel91316]

11. Most people in the US who are bankrupted by medical bills have "insurance".

Dontcha love it?

[madfloridian]

12. Medicare doesn't pay for every drug.

Not even the Medicare Advantage plans. They often do not pay for controlled substances. Here is a list from 2006 of excluded drugs. I can't find a later one.

https://www.cms.gov/PrescriptionDrugCovContra/downloads/PartDDrugsPartDExcludedDrugs.pdf