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A myPHteam Member asked a question 💭
Albuquerque, NM

I just went on original Medicare in December and have AARP secondary. I chose Medicare Part D and am on Wellcare for drug coverage. I just got info on how much they pay for my Adempas and Opsumit. It adds up to more than $250,000/year and I pay about $80/month in premiums for Part D. Wow!

February 27, 2025
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Answer Summary

Members shared their experiences navigating Medicare Part D coverage for pulmonary arterial hypertension medications, with many expressing... Read more

Members shared their experiences navigating Medicare Part D coverage for pulmonary arterial hypertension medications, with many expressing astonishment at drug costs ranging from $27,000 to over $250,000 annually while paying minimal or zero premiums and copays through plans like WellCare and United Healthcare. Several members emphasized the critical importance of researching formularies during open enrollment, filing formulary exceptions when medications are denied, and applying for financial assistance through programs like The Assistance Fund and PAN Foundation to cover gaps in insurance coverage. A recurring theme was deep gratitude for accessible insurance and foundation support that makes survival possible, alongside frustration that life-saving medications carry such extreme price tags in the first place.

A myPHteam Member

Check into the Assistance Fund. This is a pulmonary hypertension assistance program which picks up the cost where your insurance doesn't. Please try to apply.

March 11, 2025
A myPHteam Member

I am so darn lucky to be a Johnson Abd Johnson retire so 3 of the most expensive meds I take are covered at no charge. I deliberately chose meds made by Janssen, a J&J company, to maximize keeping my costs low.

March 4, 2025
A myPHteam Member

Yes, I'm on medicare, I have a supplemental and a part D plan with wellcare, I have a $2000 out of pocket per year with the option to pay all at once or divided evenly through out the year. No monthly premium On Uptravi, tadalafil and ambristentan with total of $27,600 drug cost per month that is completely paid. I have found that any insurance I have enrolled with has refused my Uptravi and we had to file a "Formulary exception" because of denial. Took about 10 days but in each instance it was accepted. Have been on these medications since 2018. Praise God I pay nothing out of pocket per month.
How do they do that? No premium for a drug insurance plan??

February 28, 2025
A myPHteam Member

I can highly recommend this fund. I have received assistance from them that covers all costs that my insurance does not pay.

March 11, 2025
A myPHteam Member

@A myPHteam Member Most of us rely on financial assistance for our meds. When I was taking PAH Tier 5 meds I was getting financing from 2 different foundations. I'm off those now as I was reclassified as Group 2 but I get my Jardiance for free from the manufacturer. I am really fortunate that my specialists have caring staff who are very helpful in the process of getting financial aid.

March 8, 2025

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