MEDICARE DRUG PRICES - 2024 AND 2025

[Virginia]

I don't know if anyone on here falls into the category that this will affect other than me. However, I will post this just in case. There are price changes to take place for many high price drugs.
Below is the way I understand it so far. I have registered for a webinar with PAN on November 29th concerning this and should find out more.

In 2024 the co-payments for all drugs will stop when a person who is on Medicare reaches the catastrophic stage. Until 2024 there have still been copayments and on the more expensive drugs, they could be quite high. In 2024 a person who reaches the catastrophic stage will pay $ .00 for the rest of the year. I normally get there in January or February. According to the information that Medicare has for my drugs I will need to pay out of pocket $3,460.00 in January. Then the rest of the year will be $ .00. However, almost $3,500.00 is more than I can pay this January, so I hope to get some help.

In 2025 the out-of-pocket cost for Medicare recipients is $2,200.00. Also, this can be spread out over a period of a year. No one will have to pay it all at once. This includes even high price cancer medications and things like that. I am unclear if it is necessary to carry a Part D, or other prescription drug plan. I will probably find this out during the webinar. I do carry a Part D drug plan so I will continue on with that. Some people have drug coverage through their past employers or their spouses.

If I get more pertinent information during the webinar I will update this.

[agate]

Virginia, what is PAN?

Thank you for posting about this. This is a new wrinkle and may affect many people who take MS drugs, including me.

I just hope that someone at Medicare or United Health Care or the pharmacy will let me know BEFORE filling my rx for Glatopa because I'll be going off the Glatopa if there is as much money involved as there is sure to be.

In other words, I hope the pharmacy doesn't refill the rx and then send a whopping bill without letting me know ahead of time.

I hope you can let us know if you have more information on this.

[Virginia]

Agate, PAN is Patient Assistance Network. They help people who qualify get all kind of high price drugs, but a person does have to carry their own drug plan. They help with the co payments and things like that. This will not affect you as far as I know, but for people like me it is a big deal. It means that beginning January 2024 all of my drugs will cost me nothing after I reach the threshold of between $3400.00 and $3500.00. As far as I have been able to determine this is a good thing because my copayments, while being lower the rest of the year they have still continued on all year.

This was brought about by the current administration to try and help Medicare recipients pay for high priced drugs. This will not affect anyone not on Medicare as far as I can determine. I should know more on the 29th of this month.

[agate]

I misunderstood what was happening. I'm so glad if there is about to be a positive change in the cost of those pricey drugs. I don't see how anyone could possibly afford to pay for any of the MS drugs.

Maybe it's because they're so special--tinkering with the immune system can't be easy, and the drugs must have taken many years of costly research and trials to develop--but how in the world could the drug companies have expected any patient to pay for them out of pocket?

Apparently they were counting on the insurance companies and other resources to pick up the tab.

[Virginia]

You are right the insurance companies and either the person on the drug or people like Patient Assistance Network have been paying. First the insurance company pays what they are going to pay and the person getting the drug has to figure out how to pay the rest, so they turn to agencies such as PAN. A lot of years they have not helped me because they didn't have enough money to go around. They depend on donations and help people with all kind of diseases that have expensive drugs. Cancer drugs are hugely expensive.

From what I am finding out the drug companies and the insurance companies are going to pick up more of the cost of these drugs for Medicare recipients allowing the co payments to decrease.

[Virginia]

Edited to add: I am kind of holding my breath to see if this really works the way it is supposed to.

[flatcap]

I have prescription drug coverage though my former employer, so I was only curious when I looked up PAN just now.

I went to the website and ran a quick test (emphasis on test; I am not on Copaxone and am, in fact, allergic to it).


Input

MS, Copaxone


Output

"The fund for Multiple Sclerosis is closed.

We don't have an open fund available for Multiple Sclerosis, but we still may be able to help.

Sign up for the wait list..."


I have nonetheless bookmarked PAN for future reference, and I appreciate having their information. I was unaware they existed.

Meantime, I plan to hold onto my former-employer-sponsored, Medicare secondary-payer BCBS plan for as long as I can afford to pay the premium. Including dental, it will cost me a little over $300/mo next year.

Inflation being what it is now, I am not sure how many more years it will be before I have to take another route, such as a Medicare Advantage plan. I will then receive a lifetime subsidy of $1200/yr from my former employer, which, combined with my fixed income, should go the distance....I hope.


ETA: I ran a similar test using Parkinson's and Carbidopa-Levodopa as inputs. Same output: The fund is closed.

[Virginia]

Flatcap, I think most of the high end disease funds are closed this time of the year. They wait for more money to come in the first of the year and everyone who uses them hopes they will get it, I am sure.