DMTs vs. Medicare?

Hello - new to this community, but not MS. I was dx in 2003, and started Copaxone in 2004.

I am now disabled and on Medicare (and do not qualify for Medicaid). The monthly copay is $1500 (which means I am not taking any DMT).

Is anyone in this group on Medicare? (Original Medicare + Part D, not an Advantage Plan) And still able to afford a Disease Modifying Therapy?

Thank you!

3 Likes

There are grants out there to help with copays . Look up the Pan (Patient Access Network) or The Assistance Fund. There are a few out there. The MS society has a list. Hope this helps you find assistance!

2 Likes

Thank you!

With medicare part D, you generally have to get a formulary exception if it isn’t on their formulary and they almost always put DMTs on level 5. I would plan to hit catastrophic coverage each year, but that does make a month or two of expensive at the beginning of every year. Do you know what you need to be medicaid eligible? What state are you in?

I am not eligible for Medicaid.

Try to get something else from your doctor, there are lots of companies that will help you with the copay. Your doctor should know about this

I am getting Ocrevus infusions, call your doctor because there are alot of companies that wiy help you.

I have my own insurance that I pay every month and they gave me a grant from avonex the biogen company. Otherwise it would have been $70 a month or $80. It was a lot so I didn’t have to pay for any of it they took what my insurance gave them and that was it the rest was free. But I’m going to my doctor today cuz this shot is making me very sick so I’m supposed to renew the paperwork so I don’t know I got paperwork in the mail I’m supposed to renew the paperwork for the grant and updated so I don’t know where it’s going to be after this?I really don’t need to renew the paperwork for this medicine if I’m not going to be taking it?