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I'm working with a husband and wife who are coming off employer coverage as the husband is retiring and they'll both be 65 in December. The wife has a condition called polymyositis and is confined to a wheelchair. She's been on Medicare A&B for several years since she didn't know she didn't need Part B being covered thru her husband's employer.
Anyway, twice a month a health aide comes to her house and administers a drug called Gammagard 500mL at a time. She maxes out her max out of pocket for their employer coverage because of this drug. However, once she gets her own Medicare supplemental insurance, I'm not sure if this drug will be a Part B or Part D expense. I did find it in the plan finder on Medicare's website, and based on the amount she needs monthly the retail cost of it is over $11,000 each month. Her copays would total almost $10k for the year since most of the year she'd be in catastrophic coverage.
Does anyone have experience with meds like this? Any chance it could be covered under Part B if she goes to have it administered in the doctor's office instead of at home? There is a pharmaceutical assistance program with this drug, and their income is pretty low as their only income will be Social Security for each. Is there a good chance she could qualify? I can't imagine how a couple living just on SS income is expected to afford this much for a drug copay.
Anyway, twice a month a health aide comes to her house and administers a drug called Gammagard 500mL at a time. She maxes out her max out of pocket for their employer coverage because of this drug. However, once she gets her own Medicare supplemental insurance, I'm not sure if this drug will be a Part B or Part D expense. I did find it in the plan finder on Medicare's website, and based on the amount she needs monthly the retail cost of it is over $11,000 each month. Her copays would total almost $10k for the year since most of the year she'd be in catastrophic coverage.
Does anyone have experience with meds like this? Any chance it could be covered under Part B if she goes to have it administered in the doctor's office instead of at home? There is a pharmaceutical assistance program with this drug, and their income is pretty low as their only income will be Social Security for each. Is there a good chance she could qualify? I can't imagine how a couple living just on SS income is expected to afford this much for a drug copay.