Besremi or Jakafi coverage on Medicare?

[Laluna5683]

Anyone on here have Medicare coverage for either of these drugs?

I just went online and see that the cost would be about $3,500 a year.

Thanks!

[hunter5582]

Coverage depends on which Medicare part D plan you are enrolled in. Both of the drugs are covered on my plan. Both cost the same $100/month copay.

[Laluna5683 in reply to hunter5582]

This is our first exploration into Medicare as I still have private insurance from my job but my husband just turned 65 and we are comparing the difference. Hunter, do you mind if I ask you which part D plan you have? We were looking at the higher cost plans and when entering the drugs- came up wit the high price.

[Laluna5683 in reply to Laluna5683]

Or actually, Hunter - the question would be who your part D carrier is…..

[hunter5582 in reply to Laluna5683]

I have a Cigna Part D plan that is provided by my former employer. It has a max co-pay of $100/month for the higher tier meds and a $2,000/annual cap.

[Ovidess]

I applied for financial aide with PharmaEssentia and am finishing my third month of "free" treatment. Applying took lots of patience--on both sides. I am not sure if they will have me continue in the new year, or if I must reapply. My Medicare plan D this coming year is with Wellcare Value Script, and the monthly premium is $0. Supposedly, if I had to pay for myself in the new year, the copay would be $3339 or so in January, then "free" for the rest of the year. This is just one scenario in the tragic comic world of American health insurance.

[sbs_patient]

I've been on Jakafi for about 16 months. Medicare coverage will depend on which Part D provider you're using. I have a Medicare Advantage plan through Geisinger, a century-old medical care provider in North Central PA; they've now been acquired by Kaiser. My cost for Jakafi this year will be something like $8K, but it will go down to under $4K in 2024 and then $2K in 2025, thanks to the Biden Medicare drug cost restrictions.

[EPguy]

I'll be on medicare next May so I've been looking. Medicare has two paths, "regular" and Advantage. Advantage combines drug with Dr/hospital etc. Adv is usually the least expensive, my husband has $0, and great when your needs are routine or the narrow network aligns with your special needs. Often vision and dental are included. Some can be fussy about expensive drugs.

For most of us with complex needs regular medicare with a supplement may be best. Among these part G supplement has the best coverage with the widest Dr networks. But you also need separate drug plan this is Part D. In context of part D:

-Medicare has "anti kickback" rules so the "free" coupons most of us get with commercial insurance are not allowed.

-If you have gov't or similar upgraded retiree benefits there may be extra help.

-For most of us, Part D plan requires meeting an income test to get the Bes or Rux co pay covered, see screen shot.

-If "no then it's going to be ~3k next year, going down to 2k in 2025 as SBS_patient notes here.

-In 2028 Rux should get a lot cheaper as the patent expires. Bes patent is good till the 2030's.

Income test

[PhysAssist in reply to EPguy]

Hi EPguy,

I'm in the same boat as you , re: starting Medicare next May.

In preparation for that event, I have an appointment with an insurance broker/specialist early next year to help me navigate the muddy waters.

Your summary was very helpful as well.

Best,

PA

[Mirror368]

Expensive drugs put you into the Medicare “Donut Hole” in 2024. Starting in 2025 there will be a maximum $2,000 out of pocket.