Pegasys - Medicare Payment Options and Dosing Schedule

[gvibes]

Hi Everyone,

I live in Connecticut in the US , have PV (exxon 12 mutation) and have been on pegasys for about 3 years. I now am on an every other week dose of 45 mcg. I am in a Medicare Advantage program. I was supported by a PAN copay program which has apparently run out and am confronted with a $500 monthly copay.

Just looking for advice as to whether I should switch to regular medicare and get a Part D drug program or other possible alternatives that might be out there.

Also since I see people on different dosing intertervals and I pay per dose apparently - wonderting if 45 every two weeks the same as 90 monthly for a drug like interferon (and can the body handle that).

thanks

[hunter5582]

Sorry to hear about the problems accessing Pegasys. Unfortunately, many Medicare Advantage programs do a poor job supporting patients on expensive medications. You may find a better program during open season.

The monthly cost of Pegasys (4 doses) is about $4,200. People with higher copay plans often cannot afford the copay without assistance.

The half-life of Pegasys = 80 hours. This is why the dosing is usually weekly, allowing the medication to always be in your body. If you wait too long then all of the Pegasys has cycled out of your body, reducing efficacy.

There is some good news in the not-too-distant future. The maximum out-of-pocket cap for Medication on Medicare will be $2,000 in 2025. It is set at $3,250 in 2024.

I hope you find a way to afford the Pegasys in this year and moving forward.

[gvibes in reply to hunter5582]

thanks Hunter. Looking into moving back to regular Medicare.

[sbs_patient in reply to gvibes]

I believe that the new limits apply to Medicare Advantage plans as well.

[gvibes in reply to sbs_patient]

Interesting. I will investigate further. Thanks

[marlenablue]

I have no advice for you but just wanted to say howdy to a fellow New Englander. I grew up in northern CT (just north of Hartford) and now live in NH, lakes region.

[gvibes in reply to marlenablue]

Howdy. Hope the winter is treating you well up there.

[marlenablue in reply to gvibes]

We got snow yesterday - between a dusting and an inch. Even still, I feel spring is right around the corner.

[Mirror368]

When you try to switch to a Medicare supplement and a part D drug plan you must go through Medical Underwriting. Be up front about everything because they can refuse payment later.

[gvibes in reply to Mirror368]

Thanks. Will do. I guess medicare is stuck with whoever we are and whatever we have at this point.

[Meatloaf9]

When I checked the cost of besremi on the Medicare website for 2024 under drug plans they all came back with an annual cost of about 3500 in 2024. Worst part was it was all due in the first month then no charge after this cap was met. It is supposed to be capped at 2000 in 2025. This cap is for Medicare beneficiaries.

If this is true your annual cost would be about half of that 500.00 per month. I don't take interferon so I don't know what those who do take it have experienced in 2024. Maybe someone who has had to pay for besremi can chime in.

I also think you will have to undergo underwriting if you want to switch to a medicare supplement. I would think with PV that if someone will accept you it would result in a higher monthly premium than standard but I have never known anyone who tried this.

Good luck with your decision, let us know what you find out. I have a medicare supplement plan G and would like to find a less expensive one, mine goes up 20 to 30% per year. I started out at about 90.00 per month at age 65 and now at age 74 my monthly premium is around 340.00 per month. The high risk rate from AARP is higher than that, I think. Check out all your options, an insurance broker that specializes in medicare supplements can do the leg work for you.

Best to you. Let us know what you find out.

[Indigo42916]

Hello,

I would definitely carefully look at options. I am on Medicare and Pegasys and have a Part D benefit as part of my retirement package. My co-pay is now $70, it doubled from last year. I dose (45 mcg) every 3 weeks, and my platelets stay stable at around 178, no fluctuations.

Good luck to you.