Will be switching to Medicare in a few months and in researching my options I'm finding Enbrel will cost me about $5000 more per year than it does on my current health insurance. What have other people done when moving to Medicare?
SueZ, I have been on biologics sinse 2012, the first time , my rhematologist prescribe an injection for me, he told me that if medicare did not pay, he had a team that would get me aproved it took like 3weeks, the first injection was embrel, I did get approved all I had to pay was out of pocket for my insurance which was no more than $6, but I wasn't on that drug except for a few weeks, because it made me so sick, seem like at first, I got so sick while taking the drugs until I got to humeria, I took that for 6 months, but it made me deathly sick when it quit working, I did try embrel, but with the same result, I finally tried cimiza, it worked 2 years, but when it stopped, I thought I was dying, I don't know if they had something going on with Vanderbilt, but I felt like a lab rat, none of the medications helped me, until they decided to do the remicaide, I tried this for a year, but the doctor had me on such a small dose, it didn't do any good,
so the pandemic happened, I could not go to my doctor's visits for about 7 months, but then I had done without it, I just didn't want to do it anymore, it really didn't help and it never threw me into slowing the beast down. I was falling ALOT had to have a CT they found a 7 mm lession on my spine which was AS, and all my disc have collapsed on top of each other, I have spurs in my neck ,all the way down to the end of my spine, the surgeon wanted me to go back to my rhematologist, to start some real agressive meds for my back, it took me a year to go back, but I told my doctor, I wanted to treat my back sgressively, because if something wasn't done I would be in a wheelchair within a year, he kept on raising the dose, but I started having trouble with my PTLs and WBC, my sed rate had gotten to 146, my Platelet count gout up to 2200, and I was sent to an oncologist, march 3,2021 I was diagnosed with myloid Leukemia, they think the remicaide caused this, but the only thing my rhematologist never told me my Platelet count was off the charts, it was my PCP, when I called and let my rhematologist know, he said it was my choice to take the remicaide, but a doctor who specializes in this cancer said I would never be able to take the remicaide again, so here I am, my AS is raging, I have had to start chemo, I will be on this for a long time, why didn't my rhematologist catch this sooner, or at least say something, someone paid for all those meds, but I fill like I short changed my self, and now there is nothing they can do for my AS, I wish I had never started the journey in the meds for AS, but we can't go back, my pain is always a 10, I am very unstable on my feet, I am on Blood thinners, because I have Developed atril,- fib, the chemo was doing it job, but as of last week my PLT count was 300+ point than what it was last week, I stay so tired, depressed, in pain. I am at my witt's end, I would tell you, if you still think the biologics force your doctor to get approval from insurance.
I don't take Enbrel or any other drugs like that. But insurance packages for medicare patients like Humana, United Healthcare have programs that include, doctor visits, prescriptions, and hospitalizations that are all part of the package for the same price as what you pay for medicare. These insurance packages are all based on medicare guidelines. I have found for myself that it is cheaper out-of-pocket costs to be in Humana or United Healthcare than using just Medicare. I don't know much more than what I have expressed here.
Call the different insurance companies and they will go over their packages for Medicare recipients and if you like one of them you can sign-up with them so when your Medicare kicks in you can be with the package you want that is best for you. The insurance people that you will be talking to are very helpful, that is what I found them to be when I went on Medicare and started looking for a better deal for myself.
I ended up going with United Healthcare when I first got into my Medicare age and I left them when they decided they were going to limit how much morphine I could have each month. That decision should be between me and my doctor, not some snot-nosed kid reading from a script as I like to call it. Good Luck, make your first call and it is easier after that.
When I went on Medicare I found an insurance program United Health care then and I am on Humana Medicare right now that does better than plain Medicare. From October to the early part of December you can change from Medicare to one of these other insurance plans, I found an insurance broker who helps me each year to pick the best policy for what I am looking for each year, he does the research for me after I tell him what I need for that year and he tells me if there are changes within my policy if I am keeping it that next year.
We don’t get the meds we want I was on Humira for years and when I got on Medicare it’s $3000 a month Enbrel has discounts but not for Medicare or Medicare. sucks we get cheated and all the old drugs.