MS Taking Betaseron

[Bob_The_Insurance_Guy]

Need help finding a plan that would help defray the very expensive Betaseron, for someone who has MS.

Currently she has Medicare Parts A and B, and a PDP. Betaseron is a Tier 4 drug everywhere I check.

She is only on Medicare, not Medicaid.

Called Evercare, and MS is not one of their Neurological Disorders covered under their SNP Plan. Before I have her qualify for Medicaid (which I doubt she will), I just wanted some feedback.

 

[somarco]

That's a tough one. I doubt if you are going to find anything better, but MA/Med supps are not my specialty.

I have some group clients on Betaseron. Runs around $2,000 per month but most of that is covered by the plan.

Just one of the reasons why I never suggest anyone buy a limited benefit Rx plan.

 

[jdeasy]

Need help finding a plan that would help defray the very expensive Betaseron, for someone who has MS.

Currently she has Medicare Parts A and B, and a PDP. Betaseron is a Tier 4 drug everywhere I check.

She is only on Medicare, not Medicaid.

Called Evercare, and MS is not one of their Neurological Disorders covered under their SNP Plan. Before I have her qualify for Medicaid (which I doubt she will), I just wanted some feedback.

Have you checked to see if she qualifies for the LIS? Here's another place I use with difficult RX problems. In most cases, they don't/can't help, but, for the few that they can help, it's been a godsend. Costs nothing to find out.

Welcome to PPARx.org

 

[policy doctor]

Depends on the county but perhaps AARP/medicare completeSecure Horizons would be a fit.

Or CIP. They go to tier 5.

 

[retread]

Depends on the county but perhaps AARP/medicare completeSecure Horizons would be a fit.

Or CIP. They go to tier 5.

A tier 5 drug is only good for the client who signs up for the Rx plan that supports it. Not every CIP plan offers tier 5 coverage. IF the drug is in the formulary, they will have access IF they select the proper plan..... doesn't matter if the drug is in the formulary or not if she doesn't qualify for the tier 5 plan.
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There are other alternatives if the client doesn't qualify for Medicaid. Some states have SPAP, which will allow some help and is not as demanding on the income/asset test as Medicaid. MO, for example doesn't even look at assets, only income.

LIS is a federal program, and if she applies through Soc Sec, they will tell her if she qualifies or not, but uses both income and asset tests. Again, less restrictive than Medicaid.

 

[Bob_The_Insurance_Guy]

Thanks, guys.

I'm going to pursue those options with her.

 

[Winter_123]

What about if she goes outside the medicare products and tries to get qualified for one of the drug assistance programs run directly by the drug companies and then gets the rest of her drugs through a more basic pdp plan.

 

[sman]

Need help finding a plan that would help defray the very expensive Betaseron, for someone who has MS.

Currently she has Medicare Parts A and B, and a PDP. Betaseron is a Tier 4 drug everywhere I check.

She is only on Medicare, not Medicaid.

Called Evercare, and MS is not one of their Neurological Disorders covered under their SNP Plan. Before I have her qualify for Medicaid (which I doubt she will), I just wanted some feedback.

How is the Betaseron administerd (i.e. - does she do it herself or is it done by the doctor or assistant)? If it is administered in the doctor's office, it may be possible to have it covered under Medicare Part B. I don't know anything about the medication, but I have clients who are on medications that are administered by the doctor and Medicare Part B covers them.

 

[retread]

How is the Betaseron administerd (i.e. - does she do it herself or is it done by the doctor or assistant)? If it is administered in the doctor's office, it may be possible to have it covered under Medicare Part B. I don't know anything about the medication, but I have clients who are on medications that are administered by the doctor and Medicare Part B covers them.

Absolutely!! If the Rx is administered in the doc's office it is covered under Part B benefits.