Hi Steven. I went to a Medicare specialist two years ago and opted for original Medicare with AARP Plan G (UHC) as my supplemental carrier. I had Wellcare in 2025 for Part D drug coverage but in 2026 they no longer listed one of my PAH drugs on their formulary (Adempas or Opsumit). The only option in New Mexico this year that covers both is SilverScripts. I don't know if Winrevair is on their formulary.
I pay $169.60 monthly for AARP and $104.00 monthly for SilverScripts. Unfortunately, our income exceeds the Medicare limit for the standard Medicare Part B monthly premium of $202.90 for 2026 so we pay considerably more per the IRMAA guidelines. I strongly suggest you read about IRMAA because it affects Part D as well. My PAH meds are provided by CVS Specialty pharmacy, they have my credit card on file and this year my $2100.00 maximum out-of-pocket was met in January. Best wishes

Just to piggyback on what Heather10 said, if your not familiar or comfortable doing it yourself, have a broker do it for you. Here in NYC there is no charge for using a broker. In my case because I see 6 specialist my insurance is complicated, but I got my medication covered. Also using a foundation that helps pay for all my formulary medication.

It’s going to vary by state..but for the most part, none of the Medicare D plans include these meds in their formularies. So it will take your doctors' filing letters of medical necessity and getting them pre-auth’d. I live in Arizona and I have Wellcare as my Medicare D plan and I have been very happy with them. While they did initially turn down a couple of requests, they ultimately approved everything I asked for on appeals. Then you have to try to get a grant to cover the co-pay portion. So you have to have the Insurance approval in order to get a grant.

Remember that each year there is a different financial hurdle to meet and once you have paid that much in co-pays and/or deductibles, you are in the “catastrophic” phase of coverage and all future co-pays for that calendar year are free. This year’s hurdle was $2100. Most PH patients make the year’s hurdle by February of each year. And grants count towards the hurdle number!

The alternative is getting the manufacturer to cover the entire cost if you can qualify financially for that.

I found any Medicare Advantage health insurance works do your research here in my state Fidelis Atena aren't accepted by many specialist . I'd go w MVP BCBS my choice was CDPHP I just love them not sure if available in your state. I get husge catalog gives providers specialist an another for medications an tier group they're considered.