switching to Medicare mid-treatment

[NJacana]

I will be on my last of 12-week treatment, with maybe traces still detected when I turn 65 and have to use Medicare. Coverage is great until then. The the medicare sales people know of no company that accepts Solivar since they are going by last year's sheet. Does anyone know where any updating is being done to reflect Solivar in their policy?

[pooh55811]

"Perhaps just thinking positive is the way to go. "
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You need to do more than think positive. In order to attain SVR (cure) you will need to complete the recommended regimen.

If you are in an HMO that does not cover your drugs, maybe you will need to get a different HMO or maybe you will need to opt for original Medicare and then pick your Part D prescription coverage.

You need to find out which Medicare Part D will cover Sovaldi and get a plan that will cover the drugs you are on.  

Research the various Part D policies and pick one that will cover Sovaldi.

I was on Medicare when I treated. My Part D plan covered the drugs I was prescribed (Incivek, Ribavirin, Interferon). At the time, Incivek was very new, just released, and cost about $62,000 for the 12 weeks of Incivek alone.

If you cannot get coverage, then research the assistance program from Gilead.

However, it is important to have good prescription drug coverage regardless of if you need it for Sovaldi. There are other diseases around that require very expensive drugs. One does not want to be in a plan that won't cover needed drugs just because they are new or expensive.

In my experience, HMO plans are not nearly as good as regular insurance plans.

[NJacana]

Thanks, Hector. I signed up for Keystone 65 HMO with the Keystone D plan. But they know nothing of Sovaldi, nor did the the home office know anything. I am just trying to choose the best plan since week 9 I still have traces and started off with a high viral load (if that has anything to do with it). I have til  May 29 to change the plan. Perhaps just thinking positive is the way to go.

[HectorSF]

There seems to be some misunderstanding of how Medicare works and how Medicare deals with insurance coverage for drugs.

First you have to decide what type of Medicare plan you want. Original Medicare or Medicare Advantage Plan (Part C) such as an HMO or PPO that offers Medicare prescription drug coverage. Depending on which you chose will determine what insurance drug plan you will have.

For example...If you decide to have original Medicare not Medicare through an HMO all drugs are covered under your Part D drug plan. Your part D drug plan is a plan you chose from a list of insurance companies that provide coverage in the area where you live.

The drug plan you chose will determine how much they will cover of the cost of treatment. Medicare itself doesn't pay for drugs your Part D or Medicare Advantage Plan (Part C) pays.

You should also be aware of the "donut hole" as the cost of treatment will probably put you in the "donut hole" very quickly.
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When you first get Medicare (Initial Enrollment Periods for Part C & Part D)

"I'm newly eligible for Medicare because I turned 65. What can I do?"

Sign up for a Medicare Advantage Plan and/or a Medicare Prescription Drug Plan.

When?

During the 7-month period that starts 3 months before the month you turn 65, includes the month you turn 65, and ends 3 months after the month you turn 65."
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To learn more about Part D follow the link.
https://www.medicare.gov/part-d/

When can I join a health or drug plan?
When you decide how to get your Medicare coverage, you might choose a Medicare Advantage Plan (Part C) and/or Medicare prescription drug coverage (Part D).

There are specific times when you can sign up for these plans, or make changes to coverage you already have. You don’t need to sign up for Medicare each year. However, each year you’ll have a chance to review your coverage and change plans.

* Find and compare plans in your area.
https://www.medicare.gov/find-a-plan/questions/home.aspx


2 ways to get drug coverage

Medicare Prescription Drug Plan (Part D). These plans (sometimes called "PDPs") add drug coverage to Original Medicare, some Medicare Cost Plans, some Medicare Private Fee-for-Service (PFFS) Plans, and Medicare Medical Savings Account (MSA) Plans.

Medicare Advantage Plan (Part C) (like an HMO or PPO) or other Medicare health plan that offers Medicare prescription drug coverage. You get all of your Medicare Part A (Hospital Insurance) and Medicare Part B (Medical Insurance) coverage, and prescription drug coverage (Part D), through these plans. Medicare Advantage Plans with prescription drug coverage are sometimes called “MA-PDs.” You must have Part A and Part B to join a Medicare Advantage Plan.

Hope this helps.
Hector

[pooh55811]

Follow the link to Gilead (company that makes Sovaldi). Click on their support pages and contact them to see if they can offer you some assistance.

http://www.gilead.com/responsibility/us-patient-access/support%20path%20for%20sovaldi

[nan535]

My husband selected a Medicare Advantage Plan when he turned 65. He has Extra Help from our state (NYS) for prescriptions (Medicare Savings Program)
His Sovaldi + Ribavrin treatment is being covered in full.
Perhaps your state has the same thing.

Wishing you good luck getting coverage for your treatment.

Nan