As a new user of Medicare (start 3/1), an... - Cure Parkinson's
As a new user of Medicare (start 3/1), any problems with PD meds in prescription plans formularies??
The Stalevo I am prescribed was not included in Medicare coverage because the strength is low. But the COSTCO pharmacy advised my daughter to apply for an exemption with a letter from my neuro explaining why I need that strength. The exemption was granted and it is now covered by Medicare. So do apply for an exemption if yours is not covered.
I have had all my PD meds covered by my prescription plan. I had the same problem as Joanne_Joyce with generic Stalevo, but a letter from my doctor got it approved, although it is expensive.
I had my neuro send and exemption letter for my tier 1 medications and they were approved took awhile so you must have a doctor send it in or they can do by phone but it takes time.
it may also depend if you are using just Medicare or are getting a Medicare advantage plan form an insurance company - those may pay for a wider number of drugs, although they could be in higher co-pay tiers. I have had Medicare Advantage plans to this point and my meds have been covered within their formulary.
we fought with the medicare supplement company to cover my husbands provigil/modafinil because it's off label use for PD. It's for narcolepsy, which is how he finally got it paid for in part. His neuro repeatedly advocated for him and gave him samples. It's expensive. He was falling as sleep and losing weight because he wasn't eating. Modafinil really improved things. Also Azilect is expensive.
We have something called Prescription Advantage in Massachusetts to help seniors with pricey drugs and that helped a lot. It goes by your income. Once he'd paid out a certain amount and was in the "donut hole" they kicked in. Check with your local council on aging. Also ask the drug company for reduced cost and appeal to the insurance company to lower their tier for you. It's a huge headache. I had to quit my job to manage all this.
My husband had a Medicare Advantage Plan and it covered all his meds. If you live in NY apply for EPIC if you are 65 or older. If your income is in the range you pay lower copays and don't have to worry about the Donut hole.
