medicare part d coverage for radicava in Florida

[steve613]

We will be starting medicare on 1/1/22 and need a good part B and D supplement that is friendly to radicava and ALS drugs. We live in Florida. Any advice on which supplement will offer the best coverage with the fewest hassles?

 

[BarrCarr]

Medicare plans are by region. What part of Florida are you in?Also you can go directly to Medicare.gov and select plans where you type in medications you us and it tells you the cost.

 

[steve613]

I am in palm beach county. The infusion company coram tells me that they dont bill medicare and that radicava is covered by part D with a $3600 monthly copay!!!

 

[Nikki J]

Are you having home infusions? Office infusions go under part B. For home infusions they used not to cover at all. Now they do but it is limited. I think you need an infusion pump to have anything covered and the relevant act was written pre Radicava There is a link in this link so you can search companies that might be more helpful Home Infusion Therapy Services | CMS

this is a Faq https://www.cms.gov/files/document/mm11880.pdf

 

[steve613]

Yes you are right, thanks Nikki. After much research and gnashing of teeth, I found that home infusions might continue but with a drug copay (with part D coverage) of $3600 a month. We were forced to withdraw from Medicare and resume the BCBS employer based coverage, since Searchlight covers the copay with commercial but not any form of government insurance.