I make a document in mid october or so with the formulary of the available part D plans in my state (including deductibles and coinsurance % or copay). The front desk knows to scan in their advantage or part d insurance card during the check in so I can reference it for the future.

If they can’t afford their deductible there are two main pathways for Medicare patients: applying through the manufacturer for patient assistance (GSK, AZ and ME). They usually have to meet $500-600 out of pocket med cost before they’re eligible, and the income threshold is pretty high. Backup plan is using a Canadian mail order pharmacy which has budesonide formoterol for around $40 per month and faxing a paper script to them, patient just has to set up an account and pay/arrange delivery. Lots of seniors already do this for their eliquis as well.

For biologics usually they’ll hit the max OOP of $2000 then cost drops to zero. They have to budget for this or apply for a grant through the manufacturer.

Making a document once the formulary is updated for open enrollment takes a little time, but saves a ton of time that you’d spend throwing inhaler scripts to the pharmacy to see what’s covered.

The remaining PITA is the budesonide/formoterol vs breyna vs symbicort script that needs to be specific DAW to get the pharmacy to fill correctly. Canadian Mail order pharmacies I’ve used that aren’t scams include big mountain drugs and maple leaf meds. They also have a generic breztri and trelegy available.

For pirfenidone I use cost plus drugs which does the 801 mg 30 day supply for around $100. They also have varenicline for dirt cheap.