Medicare Drug Plan D cost

[Monetfan2017]

My understanding is the max out-of-pocket for 2023 is around $7400 for 2023. Does this max apply to Imbruvica ?

If not, then is there a max for Specialty drugs?

Thanks

[lankisterguy Volunteer]

Hi Monetfan2017,

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The changes for 2024 in the Part D cost calculations is still being defined, we have heard numbers in the $5,000 to $7,000 range for out of pocket costs as any of the BTKs or BCL2s take you through the "donut hole."

But as in the past, we suggest you ask for help from your CLL expert doctor's staff, the specialty pharmacy that distributes those drugs and the LLS.org. (They will be dealing with the new rules in January 2024 and will know much more than us, very quickly).

I have gotten copay assistance from each of them at different time periods, as one of the three has found assistance for me, despite my income being a bit above the normal limits.

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Len

[gardening-girl]

Keep in mind Monetfan2017 that the PartD out of pocket limits only apply if the drugs that you are taking are in the formulary of your specific insurance plan and in the doses they approve of. I previously posted about the fact that my current insurer dropped the 280mg ibrutinib/Imbruvica tablet from their 2024 formulary. Yesterday when checking for coverage again, this time putting in two tablets of 140 mg/day ibrutinib/Imbruvica, I got the same message that it was not covered. One tablet/day of 70mg, 140 mg, 480 mg or 560mg are covered. One tablet/day of 280 or two tablets/day of 140mg/day are not covered!