Medicare Part D options for Rux

[EPguy]

Question for our US members:

I'm in the thick of this transition to medicare and seeking the latest info from members who are on medicare and Rux.

I'm in Plan G, Medicare Advantage is no advantage with multiple bad conditions. But it requires part D separately.

The cheapest Part D makes sense since the Rux hits the max (currently 3300) in the first month. But this is Wellcare Value Script (PDP). They deal only with CVS Caremark Specialty Pharmacy and AllianceRx Walgreens among Incyte's list. Their reviews are terrible.

**Are there members on the lower cost Part D drug plans (with no other coverage) that are happy with their pharmacy?

I liked Biologics by McKesson while on Bes and will check more which part D plans they supply. Caremark is ok for my current Rux.

[Barney50]

I am Medicare Part D and WellCare Valuescript which is now $0 premium. I am under traditional Medicare. I have been with WellCare for a little over 6 yrs and on Rux for 4 and a half years. I use my hematologist’s pharmacy which is covered by WellCare. First tried CVS and it was awful service because they didn’t order my Rux as needed. Personally, I would not use Medicare Advantage coverage because so many doctors in our area of Virginia are dropping Medicare Advantage patients. Not sure where you are but call WellCare and tell them about your concerns about CVS and Rux availability.

[EPguy in reply to Barney50]

Have you found any decent pharmacy with WellCare for Rux?

Is that CVS or CVS specialty? CVS specialty has horrible reviews. Agree on Advantage, it's increasingly unviable, and esp for pts with expensive rare conditions. (I have two)

[Barney50 in reply to EPguy]

I have had excellent service from Progressive Pharmacy, located on Broad St in Richmond. They deliver to my doctor’s office and call me to see how I am doing about 10 days before filling my script. We then arrange a pick up date that works for me. Progressive and Rux is covered under WellCare. Progressive works with grants as needed. Progressive is a special formulary pharmacy also.

[EPguy in reply to Barney50]

It seems some members have access to very convenient local Rx connected to the Dr's institution. I seem to be stuck with CVS specialty so far.

[Barney50 in reply to EPguy]

Check with your dr office. That’s where I found Progressive. You should have an alternative.

[Mirror368]

I was very interested in your posting. My husband thought about switching to WellCare this year but was hesitant since such low cost might mean problems with their giant influx of new enrollees. We decided to wait until 2025.

Starting in 2025 there will be a max out of pocket $2200 for name brands, Do not know how that will affect drug plan prices.

If you belong to Amazon Prime you could check out their drug plan costs.

Let us know how you make out.

Eileen

[EPguy in reply to Mirror368]

The max starting 2025 is supposed to be $2000. It should be inclusive of all drugs, including generic as I understand it.

My guess is the plan prices won't change much since they didn't when the 3300 limit started.

I do plan to switch to Amazon for all my other pills (Sjogren leads to a whole lot) but they don't list Jakafi. Not waiting in line at pharmacies would be nice.

[Cja1956]

I sell Medicare and am also a recipient. I also have Original Medicare and Plan G, but I have an Aetna drug plan. I don’t know if you qualify, but I get a grant for Jakafi and Cleveland Clinic, where I go for treatment, dispenses it for free. There are several patient advocacy groups that you can call and look up online to see if they will cover Jakafi.

[EPguy in reply to Cja1956]

Which pharmacy is filling your Rx? Are you satisfied with their service?

[Cja1956 in reply to EPguy]

Cleveland clinic specialty pharmacy. But I think the PAN Foundation pays for it. And I’m also a Cleveland Clinic patient.

[Cja1956 in reply to Cja1956]

Also, if you use an Aetna drug plan, they always use CVS because they own Aetna.

[EPguy in reply to Cja1956]

That is quite convenient to get it from where your Dr is.

[Cja1956 in reply to EPguy]

Yes

[Chicagopv in reply to Cja1956]

That is amazing!

[hunter5582]

I agree about using Biologics as a specialty pharmacy. Their services are much better than many others. In the past, I used The Weingart Pharmacy at Johns Hopkins (barely adequate but prone to shipping mistakes) and Accredo - Express Scripts (marginal service - ethics concerns due to vertical integration).

I continue to use Biologics on my Medicare Part D plan through Cigna. Unfortunately, Cigna will not be available next year. My former employer is looking for new plans. Hopefully, it will not be an issue next year.

[Softy125 in reply to hunter5582]

Why don't you use Kaiser? Have you considered this option? Or is it inconvenient for you?

[hunter5582 in reply to Softy125]

I think you meant this for EPguy but I will respond. I had Kaiser as an option but refused to accept it. Kaiser does not employ any MPN specialists nor any NF specialists. I would lose all of the specialty care that I need to maintain my health. I would have to give up every provider with whom I have a relationship. The same was true for the other medicare Advantage plans available. I opted for a Traditional Medicare A/B plan with a secondary Cigna for coverine meds and 90% coverage for everything with caps on all out-of-pocket expenses. While expensive, this provides me with access to the best care possible.

As many have discovered, there is often no "advantage" to Medicare Advantage other than saving money up-front. In the long-term, you can lose access to specialty care and have to pay out-of-pocket for the care you need. It is very important to develop expertise in evaluating insurance plans as they are complex. many of the "insurance agents" who you talk to on the phone are salespersons whose job is to sell you a plan regardless of what is in your best interests. Caveat emptor is the driving principle of selecting medical insurance plans.

[EPguy in reply to Softy125]

Long ago I planned to get Kaiser upon starting medicare. But then I got PV and realized the limitations Hunter discusses here. And then I got another worse disease with even fewer good Drs and would be in a real mess with an Advantage plan like Kaiser.

I actually just moved my Husband to Plan G from Kaiser. They are great for "normal" pts, but anyone can turn Abnormal in an instant.

[Softy125 in reply to hunter5582]

I have to switch to Medicare starting in August and am very bad at it. I am currently on Kaiser Permanente's silver plan and they are inviting me to stay with them on Advantage. I have blood tests every three months and take aspirin. I like that with Kaiser you don't have to find doctors, labs and pharmacies yourself. When I had Cigna, my family and I had constant problems finding doctors who accepted this insurance and dispensing medications on time.

[Mirror368 in reply to Softy125]

When you first go on Medicare you have guaranteed issue. This means no matter how many health issues you can get a Medicare supplement. Choose wisely because after that period you would need to pass medical underwriting to get a supplement. Medicare Advantage plans sound great but are known to deny services. Also, not all doctors or facilities accept them.

[EPguy in reply to Mirror368]

Your point is something not well enough publicized. My husband could switch to Plan G from Kaiser at age 71 because he has no essentially medical record.

[Mirror368 in reply to EPguy]

Do you presently have Kaiser? I do not understand how you can switch at age 71 to Plan G without medical underwriting. Your profile mentions various health issues. Always be 100% accurate filling out that form or they can deny payment for all services later.

[EPguy in reply to Mirror368]

I have been on commercial Ins PPO and I am turning 65 tomorrow. So I am now in Supplemental Plan G via the guaranteed initial enrollment. I guess most MPN pts could not switch to supp from Advantage.

The reference above was to my husband who is 72 now. He did get underwriting but has min med history and no known problems.

[EPguy in reply to hunter5582]

to hunter5582

Do you have added or secondary coverage? For example gov't employees like my mother who was a teacher get great benefits beyond a plan G Part D etc.

[hunter5582 in reply to EPguy]

Yes. I am a retired county employee. I have a secondary Cigna coverage plan in addition to Medicare A/B. Cigna also manages the medicare Part D plan. Unfortunately, Cigna is dropping their Medicare products in 2025. While I have had issues with Cigna, I was able to resolve them. My preference would be better the devil I know, but that will not be a choice. We will see what the future holds.

[Softy125 in reply to hunter5582]

As I understand it, you additionally have Medigap in Cigna. I have carefully read the Kaiser Advantage proposals and there are many things that may not be fully covered. I think with Medicare I should telan G or N in addition to Medigap. I also live in Fairfax County and have ET, tests every three months and aspirin. Could you recommend me to qualified doctors in our specialty to avoid the looming problems of the transition from Kaiser if possible? I always read your posts which are written by an experienced person. Thank you in advance.

[hunter5582 in reply to Softy125]

I am retired from Fairfax County Government, which is where my insurance is based. I split my care between a local hematologist in Loudoun County who handles on-going care (Dr. Amit Sarma) and a MPN Specialist at Johns Hopkins (Dr. Tania Jane). I previously saw Dr. Spivak then Dr, Braunstein. Unfortunately, they both left and Hopkins reorganized the department. it is a bit harder to find MPN Specialists there now.

Dr. Sarma is an outstanding hematologist but not by his own definition a MPN Specialist. He has a great manner with patients and works well in consultation with a MPN Specialist colleague. The larger practice, Virginia Cancer specialists, has offices in Fairfax. Whether you choose this practice or another, the important thing to do is to select a doctor with expertise in hematologic malignancies. Oncology/Hematology is board certified together in the USA; however, doctors have varying levels of hematology expertise. Some are more focussed on other cancers and have little/no experience with MPNs.

One of the things I like about my local hematology practice is that they have their own lab. I get my CBC results in about 5 minutes after the sample is taken. Other labs get sent out and post quickly into the patient portal so I can see them.

Wishing you all the best.

[Softy125 in reply to hunter5582]

Thank you so much! Does Dr. Sarma practice only in Leesburg?

[hunter5582 in reply to Softy125]

Loudoun is his primary location. Not sure if he goes to other locations. here is a link to the website, virginiacancerspecialists.c...

[Softy125 in reply to hunter5582]

Thank you!

[EPguy in reply to Softy125]

Medicare is confusing. Medigap is added to regular medicare (Part A and B). Medigap is plan N,G and others.

With an MPN and maybe other conditions switching from advantage to medigap may be difficult. I know for me it would be impossible. But there are Advantage plans other than Kaiser that might include the Drs you want.

[hunter5582 in reply to EPguy]

All medical Insurance is complicated. Insurance + Medicare is even more complicated. It is not helped by the duplicitous advertising that is so common with Medicare Advantage plans. The best we can do is to thoroughly research each of our options, reviewing the panels and medication formularies. It is also important o review the out-of-network options and expenses and how the approval of non-formulary medications works. None of this can be done verbally. it is essential to get everything in writing. Caveat Emptor is the essential principle in choosing insurance plans.

[Chicagopv]

I use Optum Rx and they're generally good. They send reminders about ordering. Customer service doesn't seem very well-trained, so you need to be patient. It's as if info you've given to one cs person is not seen by any others. I was paying up to $10,000/year until this year, when one month of Jakafi waas $3000 something, and now it's free. Next year, as people have said above, the limit will be less. But I have AARP MedicareRx Preferred.

[LongETinUS]

I'm not on Medicare but I listen to the news.

For years Ralph Nadar has been listing the failings of Medicare (dis)Advantage. Most of the big healthcare corporations were in the newspapers last year for ripping of patients and the gov for billions. They put in claims to the gov for worse than actual medical conditions and then provide less medical service than the patient needs. They bank the difference. Many of the recent changes to the Medicare Advantage program came after the rips offs were publicized.

Ralph still recommends traditional medicare with the appropriate (I think part D) drug supplement.

[EPguy in reply to LongETinUS]

Lately even the insurance cos are souring on Advantage as medicare got wise to the party as you say and has snuffed it to an extent.

[Ginger1017]

I have regular Medicare plan G with also Part D. My doctor hooked me up with PAN Foundation. It's a government grant for people who need RUX. They paid$3250. Now RUX is paid for for the rest of the year .Ask your dr

[EPguy in reply to Ginger1017]

I contacted PAN. I don't qualify this year.

[Ginger1017 in reply to EPguy]

I'm so sorry..... There is no way I could afford it without 😔

[EPguy in reply to Ginger1017]

It is a hardship. My income is plenty low but "phantom" income from my retirement acct makes trouble.

[sbs_patient]

I'm on Medicare Advantage by Geisinger (coverage limited to central and NE Pennsylvania), also $0 premium. They cover Rux; the medication is provided by their specialty pharmacy and delivered by UPS, with support from an oncology pharmacist. For non-specialty medications, they use a wide range of local pharmacies. They have their own network of medical centers and physicians, but their list goes far beyond their own providers. For example, my current MPN specialist is at the University of Pennsylvania, and I've also used one at Johns Hopkins. Both institutions are in-network for Geisinger.

[EPguy in reply to sbs_patient]

Your point is topical here, it seems what is avail to each depends on location, even down to zip code.

[Buggerbear]

I have never had a Medicare Advantage plan and have the basic Medicare A and B. To cover my drugs, I am fortunate enough to have BCBS Federal, however, the two together are expensive and cost me over $500 a month.

Please contact the IncyteCARES program. They offer a savings program where you pay $0 for Jakafi. They send you a card with a limitation of $11,977 per month and $25,000 per year. I have used it since March 2022 and have absolutely no co-pay. The phone number for IncyteCARES for Jakafi is 1-855-452-5234. You can also visit their website at IncyteCARES.com/Jakafi.

You do have to agree to an authorzations that your healthcare providers and insurance can disclose personal health info about you, including your medical condition and treatment, health insurance coverage and they can gather feedback on my therapy and/or disease sate. To me, this is no big deal.

Good luck to you EPguy and hope this helps! Drugs are so expensive, especially for MPNs, blood thinners, and inhalers.

[EPguy in reply to Buggerbear]

to Buggerbea

Is there an income limit on that program?

[Buggerbear]

I don't think so