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What happened to patients before 2014 when the lifetime limits were removed? Is this a new treatment? Did they die? Did charities help out? Did hospitals do sliding scale assistance?
I recently did a 3 way call with a Medicare client to a company that makes a new cancer drug (a pill instead of infusion) for a couple of specific types of lymphoma. Retail: $13,000 per month, yes, per month.
The catastrophic coverage after the RX plan would have reached the coverage gap max was still $650/month, and the gap would have been hit after 1st month, fulfilled on 2nd.
Punchline: due to client income, the pharma co would pay 100% of the cost.
Maybe because ACA based plans are a big cash cow for pharma, so they can help their reputation by giving a price break based on income.
Also, I find that ACA based plans just don't put certain RX on their formulary. My state's BCBS, for example, doesn't cover any form of Isotretinoin, more familiar to some as one of the brands, Accutane. (from a recent uninsured referral, seeking insurance for acne drug of last resort on the doc's recommendation, is OK with GoodRx discount, even though the drug will cost over $300/month,--and thanked me for the help--did plan formulary search as an FYI, even though no SEP available)
Then again, the blood disorder infusions may not be considered pharma drugs. Still, pricing seems out of hand, including infusion types.
I recently did a 3 way call with a Medicare client to a company that makes a new cancer drug (a pill instead of infusion) for a couple of specific types of lymphoma. Retail: $13,000 per month, yes, per month.
The catastrophic coverage after the RX plan would have reached the coverage gap max was still $650/month, and the gap would have been hit after 1st month, fulfilled on 2nd.
Punchline: due to client income, the pharma co would pay 100% of the cost.
Maybe because ACA based plans are a big cash cow for pharma, so they can help their reputation by giving a price break based on income.
Also, I find that ACA based plans just don't put certain RX on their formulary. My state's BCBS, for example, doesn't cover any form of Isotretinoin, more familiar to some as one of the brands, Accutane. (from a recent uninsured referral, seeking insurance for acne drug of last resort on the doc's recommendation, is OK with GoodRx discount, even though the drug will cost over $300/month,--and thanked me for the help--did plan formulary search as an FYI, even though no SEP available)
Then again, the blood disorder infusions may not be considered pharma drugs. Still, pricing seems out of hand, including infusion types.
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