Skyrizi Cost On Medicare

[newbie2001]

Hi,

I just had a meeting with a prospect who is T65 in the next few months. They are taking Skyrizi, Sunfire showed an astronomical price of $3283 co-pay in January and $19,000 per year "estimated full cost" on a PDP and similar cost on MAPD.

Any suggestions here? I know we have the $2,000 cap on med's next year but I want to make sure I am not seeing things.

Thanks.

 

[MedicareWAA]

Hi,

I just had a meeting with a prospect who is T65 in the next few months. They are taking Skyrizi, Sunfire showed an astronomical price of $3283 co-pay in January and $19,000 per year "estimated full cost" on a PDP and similar cost on MAPD.

Any suggestions here? I know we have the $2,000 cap on med's next year but I want to make sure I am not seeing things.

Thanks.

The platform gets confused about its cost. I’ve run into it with clients. This year, just assume the first fill will put them in the catastrophic phase, at which point the medicine is suddenly free.

Also I’m pretty sure most people fill it four times a year but the platform doesn’t always recognize that automatically.

This medicine is crazy expensive BUT they are pretty generous with Medicare patient assistance. I didn’t know that with my first client.

 

[newbie2001]

The platform gets confused about its cost. I’ve run into it with clients. This year, just assume the first fill will put them in the catastrophic phase, at which point the medicine is suddenly free.

Also I’m pretty sure most people fill it four times a year but the platform doesn’t always recognize that automatically.

This medicine is crazy expensive BUT they are pretty generous with Medicare patient assistance. I didn’t know that with my first client.

Yeah it just shows the one co-pay for January and that’s it.

They aren’t T65 till Feb so I guess they’ll there MOOP right away?

 

[somarco]

2025 plans, if that is what you are looking for, have not been released yet.

The $2,000 OOP cap only applies to drugs on the plan formulary.

For 2024, Skyrizi is a tier 5 drug and the patient should hit the OOP max in month one at roughly $3,333 for the drug. That price is for a single auto-injection pre-filled syringe.

Patient MAY qualify for a PAP from Abbvie.

I find that clients have little need for a PAP or grant with the OOP cap.

And yes, the drug has a $20k retail cost which will most likely kick them into the OOP cap.

 

[MedicareWAA]

Yeah it just shows the one co-pay for January and that’s it.

They aren’t T65 till Feb so I guess they’ll there MOOP right away?

Sorry, my answer was for 2024.

If they’ve got a MAPD next year, the first fill will satisfy the $2,000 MOOP. But because MAPDs have an enhanced part d benefit, the member will probably hit the $2,000 without actually paying $2,000. Same with enhanced standalone D.

Whatever they actually pay, they should then use the new MPP to pay that in installments through the rest of the plan year.

 

[newbie2001]

Sorry, my answer was for 2024.

If they’ve got a MAPD next year, the first fill will satisfy the $2,000 MOOP. But because MAPDs have an enhanced part d benefit, the member will probably hit the $2,000 without actually paying $2,000. Same with enhanced standalone D.

Whatever they actually pay, they should then use the new MPP to pay that in installments through the rest of the plan year.

And if it’s a PDP? Same situation. Hit the 2k max right away and that’s it?

 

[straightnochaser]

Yeah it just shows the one co-pay for January and that’s it.

They aren’t T65 till Feb so I guess they’ll there MOOP right away?

None of it applies next year, if they were eligible this year they would make one payment and be in catastrophic coverage..

 

[newbie2001]

None of it applies next year, if they were eligible this year they would make one payment and be in catastrophic coverage..

Right but next year they’ll hit the 2k MOOP on the PDP and that’s it

 

[vic120]

Man that cost of this drug is Skyrizi

Seriously though as long as the drug is on the formulary you will pay the max cost as others have mentioned

and that is a steal

 

[Millwood]

Man that cost of this drug is Skyrizi

Seriously though as long as the drug is on the formulary you will pay the max cost as others have mentioned

and that is a steal

Look at what people in other countries pay and it looks more like fraud than a steal.