Part B or Part D

[New kid]

Hello everyone,

Newer agent here. I have a client Medicare effective 05/01 this year, she is taking "humira" - very expensive drug. (She is injecting herself). Since the drug is $5k/mo, will this drug be covered under Medicare part B (we are talking about getting a supplement) or Part D?
Thank you,

 

[DS4]

Part D. The good news? Your client will be in the catastrophic phase after 1 Rx

 

[somarco]

If she can't qualify for Extra Help or a PAP she can ask her doc about generic drugs
Rheumatoid Arthritis Medications - GoodRx

I have a client with RA that takes plaquenil.

I also understand that autoimmune disease comes in various forms and med's that work for one person may not do the same for another.

Just offering some suggestions you might want to pass along.

 

[fed up]

AbbVie has rebates and discounts available for Humira. some Pharmacists will bill as "No Coverage" which will make eligible for huge savings.

 

[LostDollar]

If she can't qualify for Extra Help or a PAP she can ask her doc about generic drugs
Rheumatoid Arthritis Medications - GoodRx

I have a client with RA that takes plaquenil.

I also understand that autoimmune disease comes in various forms and med's that work for one person may not do the same for another.

Just offering some suggestions you might want to pass along.

Old discussions mentioned Mark's Marine Pharmacy as an option for insulin. Might also apply to Humira.

(I have no idea how this compares to the Part D catastrophic coverage-just wanted you to have the idea in the event you would find it helpful for one of your clients in the future.)

 

[kstein]

Also you can bring up infusions as those are covered under Part B .

Cimzia and remicaid are 2 popular ones

 

[Todd King]

Hello everyone,

Newer agent here. I have a client Medicare effective 05/01 this year, she is taking "humira" - very expensive drug. (She is injecting herself). Since the drug is $5k/mo, will this drug be covered under Medicare part B (we are talking about getting a supplement) or Part D?
Thank you,

If it was a drug administered in the doctor's office, it would likely be covered under Part B. Otherwise it is part D.

 

[JustinTime]

I know I'm late to this conversation, but I wanted to share some additional links that might help clarify which type of drugs are covered by Medicare Part B:

Prescription Drugs (Outpatient)
Prescription Drug Coverage

Medicare Drug Coverage under Medicare Part A, Part B, Part C, & Part D
https://www.cms.gov/outreach-and-education/outreach/partnerships/downloads/11315-p.pdf