I just cannot in my wildest dreams imagine how you all have to go through this every year. That in itself would, I would think, add stress to an already stressful illness. It also sounds complicated with all the different Part A, Part Bs, etc. and Insurance companies. My heart goes out to all of you. 🙏

Traditional Medicare D plans will usually approve the PH medications but that doesn’t mean they pay the entire amount. You always have a co-pay, which by itself can be very expensive. It generally is not too difficult to get some kind of grant to help. PH Clinics are set up to assist in the grant procurement and the application process is really not that bad.

There is a greater issue if you have a Medicare Advantage plan (Medicare C) as a few of those are dropping PH meds from their formularies altogether. But even then you may be able to get help directly from the manufacturer of the drug.

And remember, this year your maximum exposure would be $2000 for APPROVED medications if you are on a D plan.

It is certainly not a perfect system, especially on the medication side of our healthcare system. But everything is a trade off.

You are so welcome. We have to stay on top of everything, don't we!

@A myPHteam Member Medicare Part D (drug coverage) is administered through various insurance companies. Consequently, formularies vary from insurance company to insurance company. This is why you must look carefully at the drug formulary annually during open enrollment. As for procuring copay or assistance with these medications, the process does vary by source but is fairly straightforward and simple. For example, I receive copay assistance through The Assistance Fund. I was able to enroll by phone and it took less than 5 minutes. I was approved within minutes of applying.

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