Besremi on an outpatient basis

[Jamesxyz]

Hi,

Just curious, has anyone in the USA on medicare been able to get besremi injections

as an outpatient? This could dramatically reduce the cost dependinfg on coverage.

[hunter5582]

Besremi is covered under Medicare Part D. The copay varies quite widely depending on the plan. i pay $100/month on my plan until i reach the $2000 annual cap. Then it is 100% covered.

[Jamesxyz in reply to hunter5582]

Hi Hunter,

Thanks for your reply.

What part D plan do you have?

Under my part d plan my copay would average ~$1000/month .

[hunter5582 in reply to Jamesxyz]

I have a Medicare Part D plan managed by Cigna and sponsored by my former employer, which is Fairfax County. It is a good plan though not as good as the formulary for regular employees. Still a much better plan than many find readily available. I consider myself fortunate even though being on Medicare + secondary insurance costs more than just being on regular employee insurance, I did have to do extensive work to get Besremi approved as it is not on the formulary. Hopefully it will be added to the formulary by next year.

[Jamesxyz in reply to hunter5582]

Your plan is not availbale to general medicare patients.

I'm on original medicare + secondary coverage.

All part d plans available are expensive for besrem, typically

about ~$1000/month average over a full calendar year. Ouch.

I know that some patients are getting pegasys injections on

an outpatient basis. This results in zero cost if you have decent secondary coverage.

Just wondering if anyone has received besremi injections as an oupatient?

Thanks

[hunter5582 in reply to Jamesxyz]

I have never heard of patients getting Pegasys injections as an outpatient treatment. It would be interesting to learn more, particularly if it applied to Besremi too.

I am aware that I am quite fortunate to have the plan available that I do. Particular to have all of my out-of-pocket medical expenses capped annually. I could not afford a percentage share of Besremi nor some of the other meds I take. I would hate to think about the percentage share of some of the surgeries I have had.

Hope you are able to find an affordable plan that will cover Besremi.

[Jamesxyz in reply to hunter5582]

I can tell you for a fact that several people are getting the pegasys on an outpatient basis, thus completley bypassing the part D costs.

I can't imagine why the same would not be possible for besremi.

It might not be worth the hassle for you, since your part D cost is so low.

[hunter5582 in reply to Jamesxyz]

Will be interesting to hear more about this. If I understand this correctly, it would mean the medication being administered in the outpatient office. You are correct that with my low copay it would not be worth the hassle. For $1,000/month I sure would do it!

[Jamesxyz in reply to hunter5582]

Yes, the nurse at the clinic would inject you.

[hunter5582 in reply to Jamesxyz]

Inconvenient but worth $1000

[Jamesxyz in reply to hunter5582]

Perhaps not that bad, you probably have to go in for a blood draw.

That could be done at the same time.

I would do it in a heartbeat to save a thousand bucks a month (:

[EPguy in reply to Jamesxyz]

Do you know whether the 1000 is a minimum or is it a % of the total?

[charl17]

There are 4 cost sharing levels in Medicare Part D plans. If you start Besremi or any very expensive drug you will be catapulted quickly into the catastrophic cost sharing level where you pay 5% of a very large number. I believe Besremi is generally covered on an outpatient basis because it is self-administered.

If you go to the website where you can choose a plan and input only Besremi you will get some idea what it will cost. The plans for 2023 will be available on Oct 15.

[Meatloaf9 in reply to charl17]

The plans for 2023 are available to preview now. My cost with part D also averages about 1,000 per month with a first month payment of about 3400.

It would be nice to know what people on medicare and part D are actually paying and which plan you have, any comments on this?? I have PV and would like to try besremi but cost may prevent it.

I have heard that Part B medicare may cover the entire cost of besremi if you go into your hematologist office and they inject you, you would have to have a heme willing to do that, I can't remember where I read that, I think it was on one of the forums.

[EPguy in reply to charl17]

5% of 180,000 (the approx Bes cost/year) works out to 9000, not too far from the 1000/month we see here. Assuming it is an actual % and not a minimum, there is huge incentive to multi dose as I have been doing per Dr instruction. I've got 18 months to Medicare.

[Jamesxyz in reply to EPguy]

You only get to 5% when you reach catastrophic stage.

As was mentioned previously the first month will be much higher ~$3400. Ouch.

[EPguy in reply to Jamesxyz]

It seems there are big changes coming to all of this via the "Inflation Reduction Act" for our US members. Seems esp relevant to the catastrophic stage you mention.

But there are a few inconsistencies, confusing:

$7050 (in this report and rising to 7400 in 2023) is different from $3400 (in this thread). And $2000 max is less than either. I guess they are reducing the 7050 (or 3400) to 2000 and zeroing the co pay that came after that. If so the new total is $2000/year.

--

"The big news for beneficiaries is that beginning in 2025, the maximum amount they will have to pay out of pocket for prescription drugs each year will be $2,000. Here are a few important details..."

"In 2024, the year before the out-of-pocket cap takes effect, Medicare beneficiaries will no longer have any out-of-pocket costs once they enter what Medicare calls catastrophic coverage. The way catastrophic coverage works in 2022 is that once an enrollee’s out-of-pocket costs reach $7,050, they have to pay 5 percent of their prescription drug costs, with no limit. But beginning in 2024, that 5 percent coinsurance requirement will be gone and enrollees won’t have to pay anything for their prescription drugs for the rest of the year."

aarp.org/politics-society/a...

[Jamesxyz in reply to EPguy]

So to sumarrize

2023 besremi cost ~$1000/month averaged over an entire calendar year.

2024 Besremic cost $7050/year or ~$588/month over an entire calendar year.

2025 Besremi cost $2000/year or $167/month over an entire calendar year

Did I get it righht?

[EPguy in reply to Jamesxyz]

I don't know the actual answer, mostly questions. But the $2000 max by 2025 does seem likely.

[william-Indo]

So scary for Besremi's price.

Pegasys only cost to $128 per shot

[EPguy in reply to william-Indo]

I think the retail non-insurance cost depends on which country it's bought. In the US I see the PEG price is just over $1000 after a discount for the 180mcg. So if one uses one syringe per week that is 52k per year.

Still way less than 7000+ retail for one 500 mcg Bes syringe, (26x7k = 182,000+/year) This would go down to 12x7k=91,000 when it switches to one per month.

[BuckskinAsia]

I’ve been getting the shot as an outpatient. Yes I do have to go in 2 days before for a blood draw & consult. So far it’s been 0 copay

[Jamesxyz]

Are you in the USA with medicare?