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Medigap and Medicare Part D plans

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Posted 6/20/2010 5:07 PM (GMT 0)

Does any one have a recommedation for medigap and part d pharmacy insurance for those with  liver disease?

  I will be eligible for medicare due to disability Sept. 1.  I  went to a SHIP counselor for help but he was not very knowlegeable about getting medicare through disability.  I am going to stay on original medicare because it will let me stay with my current transplant center.  I read on the Medicare website that if I get a transplant while covered by medicare, Part B will cover the immunosuppressant drugs I will have to take.  I called medicare to confirm this.

As to Part D, I am looking for a plan that covers prednisone, propranol, spironolactone, furosemide, potassium chloriide, nitrofurantoin,  calcitonian, and Xifaxian.  ( and Valcyte once I get a transplant. ) I went to the local Walgreens and they printed a report that lsited five plans that would cover most of these meds. 

I am having trouble finding a plan that covers the Xifaxian, or  doesn't require step therapy, quantity limits, or pre-authorization.   I currently take 6 200mg. a day. I tried Enulose but it put me in the bathroom all day.  Between the diuretics and diarhea, it was awful.

Any one's thoughts on this matter would be appreciated.

Susie

Posted 6/20/2010 5:48 PM (GMT 0)
That was smart to ask Walgreen's about Medicare drug plans. Now that you have the names, your only job will be to choose one. They are ALL going to require preauthorization of Xifaxan. Your doctor is going to have to let them know that you MUST have this drug. It's expensive, which is why they don't want to cover it. For drugs that your insurance absolutely won't cover and you can't afford, check into the Indigent Drug Program:  http://www.top5plus5.com/Indigent%20Drug%20Programs.html

Once you are actually on Medicare, you will receive a book (Medicare and You) with all the drug plans and Part B supplementary plans in it. You will get a new book every year. You can study it and see how much co-pays will be, etc. Medicare on disability will be the same as if you were getting it at full retirement age.

You say you want the original Medicare, but then you ask about supplements.  They all include regular Medicare, but pick up the 20% that Medicare doesn't pay.  Most supplements are HMOs, though a few are PPOs.  You need to make sure of what your transplant center accepts.  You can also apply for Medicaid as a supplement, if your income is low enough.

Also, If your income is low enough, you can get Medicaid to pay for Part B and also for your Part D premiums. You don't have to receive Medicaid itself to receive this "extra help."  I don't have a Part B supplement because Mayo does not accept HMOs. This means I am responsible for 20% of the bill. However, the first 3 yrs., I was approved for their charity program, which paid for everything Medicare didn't cover. The 4th year, they turned me down, though nothing had changed on my part. I just sent them $5 a month and never had a problem. This year, they wiped out the $900 plus balance I had. You might want to see if your transplant center has a charity program such as Mayo that you can apply for.

Hugs,
Connie

Posted 6/20/2010 10:05 PM (GMT 0)
Should you receive a transplant, valcyte is only one of several meds you'll need. Valcyte is usually discontinued after a few months. You may be taking cellcept, prograf (both brand names), or other anti rejection meds(cyclosporin is the original). Other drugs that most transplant patients are prescribed is bactrim and omeprazole. Bactrim is to combat infections and omeprazole (also know as nexium or prilosec) is used because many of the meds you'll take are hard on the stomach. Prograf does have a program to help pay for the drug (except in Massachusetts). When I first had a transplant (11 months ago), they had me on prograf, cellcept, valcyte, bactrim, omeprazole, and actigall. I now take half the doses of prograf and cellcept, but no more valcyte or actigall. With a new liver, the need for diuretics and xifaxin ought to be a thing of the past. I take less pills now, than I did a year ago. I feel better, too. **David**
Posted 6/21/2010 12:22 AM (GMT 0)
David is right xifaxin will be off the list after transplant...... pre- TP any insurance will require the DR to submit appropriately. Doug was never refused for it. The only problem was synthetic verses human insulin he needed human and they refused.
Sue
Posted 6/21/2010 3:47 AM (GMT 0)
Susie - You will want to stay away from any plans that require step therapy and I would recommend that you also get something that covers the "donut hole" as you will have high drug costs now and after the transplant. Many of your drugs will require a pre authorization/formulary exceptions and the doctors are usually good about knowing this and completing the paperwork timely. You should have access to any on line tools where you can plug in the drug and see the coverage - this may be a good idea to get a sense of which plans will cover the most drugs with the least hassle - sorry, but there is not a real easy answer. Good luck!
Posted 6/21/2010 3:01 PM (GMT 0)
I am eligbile for both Part A and Part B.  So it was my understanding that a medigap policy would cover the 20% that they will not.  I am looking at Plan f for coverage.

As to medicines, any immunosupptressant drug I  shouldll be covered by original Medicare part B and the medigap insurance. if I am transplanted under medicare.  My major concern is the Xifaxan pre transplant and the cost of post transplant drugs.

Kathleen-  I have only found part d plans that cover generics during the donut hole.  Is this what you are talking about?

Susie

Posted 6/22/2010 12:56 AM (GMT 0)
Not sure what state you are in Susie, but you should be able to find a plan that has the same coverage through the donut hole - but that is going away with Health Care Reform, just not right away.

Now, Part D is the drug coverage - The medigap policy will only cover those expenses not covered by Part A and B - You do need Rx coverage under Part D and you DO want to elect it when you become eligible or you will be penalized and have to pay more for the same coverage.

You can change your election once per year. On the Xifaxan, you will not need this once you have a TP but most companies require you to jump through hoops for it. Also, you may want to talk to an insurance agent - a good one can help you wade through all the muck - pick one that can offer coverage from all the players - it is really complicated and there are a ton of plans out there to choose from. You can change every year during "open enrollment" in the fall and winter up to December 31 for the next calendar year. Hope this helps!
Posted 6/22/2010 3:18 AM (GMT 0)
I was turned down for xifaxin the first time my hepatologist called it in. His PA was terrific and she wrote a letter to BC/BS saying that it would be less damaging to my liver.
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