dj12
Newbie
Posts: 7
|
Post by dj12 on Jun 16, 2021 9:46:52 GMT -5
At first glance, Mannkind's announcement that it is participating in the Medicare Savings Model sounds like a really positive step for Afrezza sales. The problem is that virtually no medicare plan formularies include Afrezza. Am I missing something or this announcement a nothingburger. |
|
|
|
Post by peppy on Jun 16, 2021 9:52:39 GMT -5
At first glance, Mannkind's announcement that it is participating in the Medicare Savings Model sounds like a really positive step for Afrezza sales. The problem is that virtually no medicare plan formularies include Afrezza. Am I missing something or this announcement a nothingburger. Also known as Catch 22? |
|
|
|
Post by morfu on Jun 16, 2021 9:57:54 GMT -5
At first glance, Mannkind's announcement that it is participating in the Medicare Savings Model sounds like a really positive step for Afrezza sales. The problem is that virtually no medicare plan formularies include Afrezza. Am I missing something or this announcement a nothingburger. hmm I wonder if you might be wrong about that.. since apparently Mannkind does a lot of business using Eagle Pharmacy and Medicare seems to work fine with them.. can anyone comment on that? |
|
|
|
Post by oldfishtowner on Jun 16, 2021 10:25:05 GMT -5
At first glance, Mannkind's announcement that it is participating in the Medicare Savings Model sounds like a really positive step for Afrezza sales. The problem is that virtually no medicare plan formularies include Afrezza. Am I missing something or this announcement a nothingburger. hmm I wonder if you might be wrong about that.. since apparently Mannkind does a lot of business using Eagle Pharmacy and Medicare seems to work fine with them.. can anyone comment on that? That's this year. But what about next year.
"Part D sponsors participating in the Model will offer beneficiaries plan choices that provide broad access to multiple types of insulin, marketed by Model-participating pharmaceutical manufacturers, at a maximum $35 copay for a 30-days’ supply in the deductible, initial coverage, and coverage gap phases of the Part D benefit. As a result, beneficiaries who take insulin and enroll in a plan participating in the Model should save an average of $446 in annual out-of-pocket costs on insulin, or over 66 percent, relative to their average cost-sharing today. This predictable copay will provide improved access to and affordability of insulin in order to improve management of beneficiaries who require insulin as part of their care." www.cms.gov/newsroom/fact-sheets/part-d-senior-savings-model
Does this require Part D insurers who participate to include all participating manufacturers' products? The purpose after all is to provide "increased choice".
|
|
dj12
Newbie
Posts: 7
|
Post by dj12 on Jun 16, 2021 10:36:06 GMT -5
hmm I wonder if you might be wrong about that.. since apparently Mannkind does a lot of business using Eagle Pharmacy and Medicare seems to work fine with them.. can anyone comment on that? That's this year. But what about next year.
"Part D sponsors participating in the Model will offer beneficiaries plan choices that provide broad access to multiple types of insulin, marketed by Model-participating pharmaceutical manufacturers, at a maximum $35 copay for a 30-days’ supply in the deductible, initial coverage, and coverage gap phases of the Part D benefit. As a result, beneficiaries who take insulin and enroll in a plan participating in the Model should save an average of $446 in annual out-of-pocket costs on insulin, or over 66 percent, relative to their average cost-sharing today. This predictable copay will provide improved access to and affordability of insulin in order to improve management of beneficiaries who require insulin as part of their care." www.cms.gov/newsroom/fact-sheets/part-d-senior-savings-model
Does this require Part D insurers who participate to include all participating manufacturers' products? The purpose after all is to provide "increased choice".
This is the part of that fact-sheet that lead me to believe if must be on the formulary: Most medicare formularies have only one brand of insulin, so I don't know what "broad set" means in this context. |
|
|
|
Post by nylefty on Jun 16, 2021 10:56:39 GMT -5
At first glance, Mannkind's announcement that it is participating in the Medicare Savings Model sounds like a really positive step for Afrezza sales. The problem is that virtually no medicare plan formularies include Afrezza. Am I missing something or this announcement a nothingburger. hmm I wonder if you might be wrong about that.. since apparently Mannkind does a lot of business using Eagle Pharmacy and Medicare seems to work fine with them.. can anyone comment on that? Medicare doesn't cover prescriptiom drugs with the exception of drugs that are administered in hospitals or have to be administered in doctors' offices. Medicare Part D plans are offered by private insurance companies such as Aetna. I have an Aetna Medicare Advantage plan that does not cover Afrezza. If I were a diabetic and since Afrezza is not covered by my insurance I could pay out of pocket and get it from Eagle, but I have no idea what you mean by "Medicare seems to work fine with them." |
|
|
|
Post by morfu on Jun 16, 2021 15:12:04 GMT -5
hmm I wonder if you might be wrong about that.. since apparently Mannkind does a lot of business using Eagle Pharmacy and Medicare seems to work fine with them.. can anyone comment on that? Medicare doesn't cover prescriptiom drugs with the exception of drugs that are administered in hospitals or have to be administered in doctors' offices. Medicare Part D plans are offered by private insurance companies such as Aetna. I have an Aetna Medicare Advantage plan that does not cover Afrezza. If I were a diabetic and since Afrezza is not covered by my insurance I could pay out of pocket and get it from Eagle, but I have no idea what you mean by "Medicare seems to work fine with them." As an diabetic you would have to change your medicare plan and would be eligible, right!? Or maybe will be covered starting next year!?
|
|
dj12
Newbie
Posts: 7
|
Post by dj12 on Jun 16, 2021 15:30:38 GMT -5
Medicare doesn't cover prescriptiom drugs with the exception of drugs that are administered in hospitals or have to be administered in doctors' offices. Medicare Part D plans are offered by private insurance companies such as Aetna. I have an Aetna Medicare Advantage plan that does not cover Afrezza. If I were a diabetic and since Afrezza is not covered by my insurance I could pay out of pocket and get it from Eagle, but I have no idea what you mean by "Medicare seems to work fine with them." As an diabetic you would have to change your medicare plan and would be eligible, right!? Or maybe will be covered starting next year!?
As of now, changing plans won't help because no plans include Afrezza in their formulary (as far as I'm aware). This is a deliberate choice by plans to exclude Afrezza. |
|
|
|
Post by nylefty on Jun 16, 2021 18:04:04 GMT -5
As an diabetic you would have to change your medicare plan and would be eligible, right!? Or maybe will be covered starting next year!?
As of now, changing plans won't help because no plans include Afrezza in their formulary (as far as I'm aware). This is a deliberate choice by plans to exclude Afrezza. I think there are a few employer retirement plans that do include Afrezza, with a prior authorization requirement. I'm a General Electric retiree and was paying for a GE health plan that did cover Afrezza, with a PA requirement. I dropped the plan because the premium was getting too high and subscribed to an Aetna Medicare Advantage plan that only costs $51 a month, but does not have Afrezza in its forumulary. If I do becoma a diabetic I'll probably regret dropping the GE plan because I don't think this "Senior Savings" plan will require insurance plans to cover Afrezza. |
|
|
|
Post by morfu on Jun 16, 2021 21:09:09 GMT -5
As of now, changing plans won't help because no plans include Afrezza in their formulary (as far as I'm aware). This is a deliberate choice by plans to exclude Afrezza. I think there are a few employer retirement plans that do include Afrezza, with a prior authorization requirement. I'm a General Electric retiree and was paying for a GE health plan that did cover Afrezza, with a PA requirement. I dropped the plan because the premium was getting too high and subscribed to an Aetna Medicare Advantage plan that only costs $51 a month, but does not have Afrezza in its forumulary. If I do becoma a diabetic I'll probably regret dropping the GE plan because I don't think this "Senior Savings" plan will require insurance plans to cover Afrezza. Well, first of all I wish you well!! Second I ave limited knowledge of the US healthcare plans, but if I may use you are an example, if needs be, you could switch your plan to one which includes Afrezza, right? (of course that would be more expensive.. 51$ a month sounds very reasonable!)
dj12 said >>no plans include Afrezza in their formulary hmm.. my limited knowledge shines.. but.. is that for this year or Mannkinds plans for next year as well? I thought in future "some Medicare" would include Afrezza from 2022 on.. this is all so confusing 
|
|
|
|
Post by sportsrancho on Jun 16, 2021 21:32:13 GMT -5
|
|
|
|
Post by morfu on Jun 17, 2021 7:47:26 GMT -5
goodrx page states
"Do Medicare prescription drug plans cover Afrezza?
No.
In general, Medicare prescription drug plans (Part D) do not cover this drug." But has a link to an Afrezza Patient Savings Card "Eligible commercially insured patients may pay as little as $15 per prescription fill."
afrezza page states: "If you have Medicare Part D coverage and are eligible for Part D Low Income Subsidy, you may pay $9.20 or less per month for your prescription."
I guess that card is the regular way to go for!? Is that what the majority of Afrezza users do?
|
|
dj12
Newbie
Posts: 7
|
Post by dj12 on Jun 17, 2021 10:08:55 GMT -5
goodrx page states
"Do Medicare prescription drug plans cover Afrezza?
No.
In general, Medicare prescription drug plans (Part D) do not cover this drug." But has a link to an Afrezza Patient Savings Card "Eligible commercially insured patients may pay as little as $15 per prescription fill."
afrezza page states: "If you have Medicare Part D coverage and are eligible for Part D Low Income Subsidy, you may pay $9.20 or less per month for your prescription."
I guess that card is the regular way to go for!? Is that what the majority of Afrezza users do?
The card is invalid for Medicare Part D beneficiaries. From what I've been told, Medicare part D beneficiaries usually cannot get Afrezza through their plans. Even if their Part D plans give them a special exception, the cost is more than the "cash pay" option. |
|
|
|
Post by nylefty on Jun 17, 2021 13:12:36 GMT -5
goodrx page states
"Do Medicare prescription drug plans cover Afrezza?
No.
In general, Medicare prescription drug plans (Part D) do not cover this drug." But has a link to an Afrezza Patient Savings Card "Eligible commercially insured patients may pay as little as $15 per prescription fill."
afrezza page states: "If you have Medicare Part D coverage and are eligible for Part D Low Income Subsidy, you may pay $9.20 or less per month for your prescription."
I guess that card is the regular way to go for!? Is that what the majority of Afrezza users do?
The card is invalid for Medicare Part D beneficiaries. From what I've been told, Medicare part D beneficiaries usually cannot get Afrezza through their plans. Even if their Part D plans give them a special exception, the cost is more than the "cash pay" option. I just discovered that Medicare Advantage plans are NOT considered Medicare Part D plans. They're Medicare Part C plans and therefore wouldn't be affected by the Senior Savings program. According to www.medicareadvantage.com there are more than 24 million people covered by Medicare Advantage plans. Almost all of these plans do not cover Afrezza or if they do it's often cheaper to buy it from Eagle Pharmacy. |
|
|
|
Post by peppy on Jun 17, 2021 13:16:48 GMT -5
The card is invalid for Medicare Part D beneficiaries. From what I've been told, Medicare part D beneficiaries usually cannot get Afrezza through their plans. Even if their Part D plans give them a special exception, the cost is more than the "cash pay" option. I just discovered that Medicare Advantage plans are NOT considered Medicare Part D plans. They're Medicare Part C plans and therefore wouldn't be affected by the Senior Savings program. According to www.medicareadvantage.com there are more than 24 million people covered by Medicare Advantage plans. Almost all of these plans do not cover Afrezza or if they do it's often cheaper to buy it from Eagle Pharmacy.Of Course! |
|
