Immunosuppressants- Cost with Medicare (primary) BCBS secondary

[inga]

Hello, I'm trying to plan ahead. For those that have Medicare primary, how much do you pay per month for immunosuppressants? Also, are they covered under part B? If Medicare is primary and BCBS is secondary (and if I don't have part D from Medicare) would BCBS prescriptions be the one to cover prescriptions or would Medicare part b cover 80% then BCBS prescriptions cover the remainder? Thanks so much, this is all so confusing.

[frankswife]

BSBS will pay for all your scripts EXCEPT the anti-rejection meds if Medicare is primary. Those have to be billed through Medicare, which pays 80% and you have to pay the rest. However, you can then submit a form for reimbursement for your portion to BCBS. The 20% of my husbands anti rejection meds is about $102. I submit the form to MVP, and the refund me $82, which is the amount I paid minus my normal drug copay of $10 per script. Hope this helps.

[nursey66]

My hubbys cost is about $97 with Midicare paying the 80%. I was surprised, was told it would be 3-4.00 hundred dollars a month. We have Medicare and BCBS MN Cost Plan and a part D as well. We are not complaining, his binders were triple or more that cost !!! We haven't purchased anti rejection drugs since I retired from work and also went on Medicare. He used to get them for a small copay when I worked and he was on my insurance.  The Medicare is really decent !!

[SooMK]

My immunosuppressants are covered under Medicare Part B and my Medicare Supplemental. Between these two I have no monthly cost for my immunosuppressants. I was very confused about this because the financial advisor at the hospital gave us similar predictions of high costs for us. The first year was a real hit with some of the other meds which came under Part D. The Valcyte cost (may have changed by now) put me into the donut hole and that was very expensive. So much so that I was in the catastrophic stage after a few months. I was fortunate that my transplant was early enough in the year that I was off the Valcyte before the end of December so I didn't have to start the meter from zero all over again. Good luck untangling this ball of yarn.

[cattlekid]

It really all depends on how your flavor of BCBS coordinates with Medicare.  My employer self-insures and BCBS administers the benefits.  In our situation, BCBS does not pick up the 20% until the OOP maximum is met.  So I am on the hook for $4000 per year of co-pays, which includes anything hospital, doctor or pharmacy.  Right now, one of my immunosuppressives (generic Cellcept/Myfortic) is $65 per month and I don't know what the generic Prograf will be until I have to get it filled under Medicare, which I have been able to put off for quite a while due to dosage decreases.

[Simon Dog]

I have been able to put off for quite a while due to dosage decreases.

For any med, it helps to have a cooperative MD over prescribe, particularly if it doesn't make you break pills.  Prescribed a drug every other day?  Ask for a daily Rx.   Prescribed a 50mg dose of something - get an Rx for 100mg.  Just be sure to remember your MDs "real" instructions since the label will differ.    If you can do this, you will cut your out of pocket.

[cattlekid]

Agreed entirely.  That's how I cut the cost of my binders dramatically when I was on dialysis.  I used a combination of generic calcium acetate and Renvela.  My neph prescribed the max dose of both.  I got the Renvela with a discount coupon so between the generic calcium acetate and the discounted Renvela, I didn't go broke buying binders.  I would adjust the ratio of calcium acetate/Renvela as my labs indicated.

I have been able to put off for quite a while due to dosage decreases.

For any med, it helps to have a cooperative MD over prescribe, particularly if it doesn't make you break pills.  Prescribed a drug every other day?  Ask for a daily Rx.   Prescribed a 50mg dose of something - get an Rx for 100mg.  Just be sure to remember your MDs "real" instructions since the label will differ.    If you can do this, you will cut your out of pocket.