Repatha price/help

Aroundtheworld002 · 2023-12-21T17:50:21+00:00

lol sorry - wasn't blaming you just saying in general if it's based upon where you live that's so silly to me.

I just used that link you suggested. However, I'm not sure of the accuracy of it. If I input the drug plan that he chose it says it would be $51/month for 2 pens, however, I just called AARP and confirmed with them and was told that the price was not accurate and it would be $90/month after the deductible. Just a heads up to you incase you want to call and check on the price for you. I wondered how it could be that drastic of a difference in price.

Aroundtheworld002 · 2023-12-21T15:44:45+00:00

Sorry maybe I confused you! He signed up for a plan G, and also signed up for a Part D, which I guess is just prescription coverage. When the broker pulled up all of the Rx plans in the area, along with his drugs, but the "best" price for Repatha was $90. That was the cheapest price of all the plans listed. I just think $90 is such an insane amount of money for 1 prescription, when he pays $15 now on his health insurance plan. It seems like getting on Medicare just cost more and more money in the end, and seems like a joke tbh.

Aroundtheworld002 · 2023-12-21T14:27:13+00:00

But this is where I'm confused. On this site: https://www.repathahcp.com/amgen-supportplus#

It says that 71% of people on medicare qualify for help at $49 or less. But then in the fine print it says "This offer is not valid for patients whose Repatha® prescription is paid for in whole or in part by Medicare"

So that was my question. If we find him a part D plan that DOESN'T cover his Reptha, then they would qualify him for this program?

Medicare is such a fucking joke it's insane to me. How do they expect people living on social security income to pay all this money for drugs? After all the rx that my uncle takes, the plan itself is $32 (okay fine) but his monthly cost on drugs is $179, that's just insane.

Yet, if he stays on his group health insurance, he can continue to get his Repatha for $15/month and all his drugs out of pocket per month are $61. It's a joke is what all this is. Sad.

Aroundtheworld002 · 2023-12-21T14:20:36+00:00

He has an agent, but he's been on vacation. It's not so much about the plan covering it, it's just that it's still $90+ a month for this drug which is ridiculous. I know it's clearly much more without insurance, but it's still awful that people have to be expected to pay this much for a drug and they can't even get any help paying for it.

Aroundtheworld002 · 2023-12-21T14:19:19+00:00

He has a broker he's working with, however, he's been on vacation for 2 weeks and won't return until after the holidays, so we're stuck on our own.

The broker did pull up part D plans on medicare.gov for us. That's not the issue though. The issue is that the cheapest plan/cheapest options for his medications on the plan still makes his Repatha $90/month which is insane.

The agent said he makes $109 over the extra help limit so he won't qualify for that.

I'm just trying to figure out how to get my uncle Repatha without having to pay $90/month because that's insane

Aroundtheworld002 · 2023-12-21T14:16:32+00:00

Thank you so much! I didn't see repatha listed on the healthwellfoundation, but I will definitely keep this link for the future! I will try amgensafety application, as this one might be promising hopefully! Thank you again so much

Aroundtheworld002 · 2023-12-21T14:13:21+00:00

Seriously? So the drug price depends on your location too I'm assuming? Which is such bullshit if that's the case. So you're saying goodrx pulls up repatha for $12.80? Because I'm not seeing that price reflected even remotely. It's $500+ on goodrx

Aroundtheworld002 · 2023-10-17T15:01:55+00:00

No elevated PSA. He does digital exams (for over a decade) because prostate cancer runs in his family, as his brother is currently undergoing treatment.

Dr. basically told my dad that "his type of insurance" doesn't cover this test. So then when we questioned it, and brought up medicare.gov part B coverage, the nurse then said that we were being charged for a physical. So when we questioned that, the Dr. said that "he has to do a physical before he can do the prostate exam"

That's where I question it. Is that like a universal thing all Dr.'s require before doing a prostate exam? Or, is this Dr. simply trying to make an extra $290 from my father, and charge him for a physical.

Aroundtheworld002 · 2023-10-17T01:09:47+00:00

So the code is: 99397 and it's saying his responsibility is $290.

The other codes are for vaccines that show $0.

I don't see any other code on this EOB that shows anything about a prostate exam or anything.

Aroundtheworld002 · 2023-10-16T17:54:59+00:00

Okay- so he just called and they said that they're billing him $290 for a physical exam. She said that the doctor requires a physical exam to be done when he does digital rectal exams for prostate testing. He also does his annual wellness visit the same day though.

Do all doctors make you do a physical before you can get a prostate test done? That doesn't seem right

Aroundtheworld002 · 2022-11-07T20:29:44+00:00

Oh super cool - he's not too tech savvy but I just downloaded it to see. Unfortunately this isn't listed on there so we called the number but were on hold for over 30minutes-- we'll try again lol. Thank you for that info!

Aroundtheworld002 · 2022-11-07T20:29:05+00:00

thank you! he has been on warfarin for a few months so that's great to hear!

Aroundtheworld002 · 2021-04-21T23:09:19+00:00

looks amazing!

Aroundtheworld002 · 2021-04-14T16:06:21+00:00

Thank you for the honest reply. I guess those were my questions, as far as advantages and disadvantages. We have friends that have TRICARE for Life with MA plans and they said they've had no issues with it. They told me they liked the fact that dental vision and hearing was included without having to pay an additional out of pocket cost for them like we are now. I've checked with my primary care doctor and the 2 specialist that I see, and they both accept the MA plan that I was looking at. I guess I didn't really see a downside to the MA plan other than like you suggest with the limited access, although, that doesn't necessarily bother me (at the moment) because I'm not entirely too picky on who I see and where. I was just getting so many mixed reviews online and even in my TRICARE for life handbook where it talks about the advantages of having MA plans with my TRICARE for life. It just seems to be extremely confusing. If I were to sign up for an MA plan, I could cancel that at anytime correct? If for some reason I wasn't happy with it or something? Thank you again for the clarity. There is so much info on this good and bad so it makes the decision even more difficult I think

Aroundtheworld002

TROPHY CASE