Great Change In Part D in 2024

[wizzard166]

I saw the message today about the proposed price control for ten drugs, one of which is Imbrutinib (Imbruvica). I agree that whether or not these changes ever take place is a huge question mark, since the Administration can change a lot between now and then.

One change from that same 2022 law that will however absolutely happen is the Change to Part D. This change will without question help all of us who take the grossly expensive Novel Targeted Therapeutic pills, which includes Imbruvica (Imbrutinib), Venclexta, etc. It will also help all of us on Medicare Part D with any other grossly expensive drugs.

The new change in 2024 is that the Catastrophic Stage of Part D Rx coverage has been eliminated. So now when we enter Catastrophic Stage, which we all do in the first Month of the year, the remainder of the year will no longer be charged to us at 5% of Cost. In other words we will pay $0. In the case of Imbruvica for example the Catastrophic Stage 5% of Cost is around $800/month. So after we have gone through Deductible, Initial Stage, and GAP (all still in our first Month), we actually fall into Catestrophic in the first Month too. Then months 2 through 12 in 2023 we have been paying over $800/Month. In 2024, with the elimination of Catastrophic Stage, we no longer will pay anything after the first Month.

For those who were not aware of this change, you now have something to be thankful for in 2024. You might also want to know that more change is coming in 2025, from that same 2022 law. In 2025 the next change to Part D takes place. All out of pocket expensed in Part D coverage will then have a Maximum Out Off Pocket for the year of $2,000. Unfortunately that change takes place after the next Presidential election, so it could be eliminated; we'll see what happens. The 2024 beautiful change for us cannot be stopped, and we all will benefit from it this coming year.

Carl

[neurodervish]

It's truly groundbreaking to finally see this happening.

Part D Improvements cms.gov/inflation-reduction...

People with Medicare will benefit from lower prescription drug costs and a redesigned prescription drug program. Benefits include:

▪️ Insulin available at $35/month per covered prescription (down by 70%)

▪️ Access to recommended adult vaccines without cost-sharing

▪️ A yearly cap ($2,000 in 2025) on out-of-pocket prescription drug costs in Medicare

▪️ Expansion of the low-income subsidy program (LIS or “Extra Help”) under Medicare Part D to 150% of the federal poverty level starting in 2024

[Kingfish6]

You wouldn't see any effect until '26. Nor will the effect be anything much that you'd notice. It is what -- $14k/month? My 60 pills is $11.4k/ mo. This will the US govt be able to negotiate a substantial reduction? Doubt it

[wizzard166 in reply to Kingfish6]

Kingfish

The good news I'm referencing is not the negotiation on the ten medications. I'm referencing the elimination of the Catastrophic Stage of Part D Rx coverage. That will help you a lot in 2024

Carl

[CLLCalifornia-USA]

Thanks Carl. You made my day.☺️Sally

[Sandlot]

That is such great news. I just wish that Calquence was one of the drugs.

[wizzard166 in reply to Sandlot]

Sandlot

I think you are misunderstanding the great news. In my post I'm not referencing the part of the law that demands negotiation between the Government and Big Pharma on the ten medications mentioned; one of which, is Imbruvica.

My post is about the part of the law that will eliminate the Catastrophic Stage of Part D coverage as of January 2024. EVERY medication covered by Part D, including Calquence, will benefit from the elimination of the Catastrophic Stage of Part D coverage.

Every medication will still go through the Deductible Stage, Initial Coverage Stage, and GAP. No medication as of January 2024 will go through the Catastrophic Stage any longer. In 2024 those of us on the Novel Targeted Therapeutic medications, such as Imbruvica and Calquence and Venatoclex, etc. will still suffer in our first month of the year. We will go through all of the first three stages of Part D Rx coverage. In many instances that will mean a little over $3,000 in our first month of use in the year. The good news is in 2023 we still go into Catastrophic Stage and pay about $800/month, but in 2024 there is no longer a Catastrophic Stage. So we will be saved from eleven months of about $800/month in 2024.

I can look up the actual costs of each medication people use in each of the stages of Part D Rx coverage. Its easy for me; its part of my work. If it would help anyone, I'd be glad to do that for them.

Carl

[Podgeof5 in reply to wizzard166]

Thanks, Carl, for this important information.

[Sandlot in reply to wizzard166]

Oh my gosh! I totally did not understand that! You have just made my day! Thank you so much!