Medicare issues
I cannot be the only one who can’t afford treatment because Medicare only covers a small portion of the IV costs and medication. Need recommendations as I have no other options I have not already tried.
It really is shameful that Medicare doesn't cover more of the costs of RA medications,
. New laws adopted last year will allow Medicare to negotiate with drug companies, bringing down costs, but it will take several years to take effective. That leaves people like you with few options and lots of pain. Have you tried the PAN Foundation? Here is a link: https://www.panfoundation.org/?fbclid=IwAR38I85fWCNCX7vOPpKZJoA9yO5yZ16ZjSa3WBIZyDJoq3_go5XPjNocO2s. Another option is to meet with a Medicare specialist to select a Part D plan that gives you better coverage for your medications. In the meantime, here are a few articles from our advocates about alternative treatments for pain relief: https://rheumatoidarthritis.net/living/accessible-pain-management and https://rheumatoidarthritis.net/living/pain-relief-trailblazer. I hope some of this helps and that you find effective and affordable treatment. Wishing you the best. - Lori (Team Member) 
You're definitely not the only one in this situation,
.
I hate that any person may be unable to afford life changing or life saving treatments, but it's the reality we live in.
I can't really add more to what Lori already shared, but if I come across any helpful information, I will be sure to come back here and let you know.
Best, Erin, RheumatoidArthritis.net Team Member.
Hi
. One of the many things that is confusing about how Medicare currently handles biologic medications is that the injectables come under Part D, but the infusions come under Part B because the infusions are generally not self-administered. This article goes into further detail https://www.cms.gov/outreach-and-education/outreach/partnerships/downloads/11315-p.pdf. The question then, of course, is how much/percentage is covered? Each state has a State Health Insurance Assistance Program (SHIP) and you can locate yours on this site to contact for help with questions on coverage: https://www.shiphelp.org/. In addition, while the manufacturers can't offer the regular copayment assistance programs to Medicare patients, it may be helpful to contact the manufacturer to find out about options. Wishing you the best. Richard (RheumatoidArthritis.net Team) Richard, that information is helpful. Now, I question, since you mentioned the kickback statue (which i discovered yesterday) , people who work for company's with more than 20 employees are able to keep their company's insurance and copay assistance because they don't have to use Medicare. Since the copay card is considered by Medicare to be a kickback, shouldn't that copay be considered taxable income? These folks have to sign up for Medicare when turn 65, therefore, technically, they are Medicare patients even though they don't use plan d. Sorry, this makes me very angry. I feel discriminated because I work for a company with fewer than 20 employees AND I will be a Medicare patient in December. Can this process/ordeal possibly be made more complicated? Probably so. REVISE THE KICKBACK STATUE. Hi
. I know you are not alone in feeling that the rule regarding how the kickback statute is applied to medications needs revision. In fact, in the metanalysis I linked to earlier one of the studies looked at involved the impact of the revision of Massachusetts's state version of the kickback statute. That said, Medicare is an individual program and the law requires each person to sign up at 65 (with penalties if they do not), even if they have private insurance. The private insurance automatically becomes the supplemental insurance (see https://www.medicare.gov/basics/get-started-with-medicare/sign-up/when-does-medicare-coverage-start for more information). I want to stress that I am far from an expert on insurance or the Medicare system. Each state does have a State Health Insurance Program (SHIP) that can be contacted for more information (see: https://www.shiphelp.org/). Hope this information helps. Best, Richard (RheumatoidArthritis.net Team)
Contact the manufacturer and see if you qualify for free product. I am on social security and am 75 years old and get Actemra free of charge, have also gotten Xeljanz free of charge. The
Effort is worth it.
Thank you for sharing - so wonderful you qualify for the free product! Warmly - Reggie, RheumatoidArthritis.net team member
