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Medicare does not cover biologics.

Wallace007

My wife and I are almost 70. Medicare is out primary insurance. We also carry a Medicare supplement and prescription plan. Medicare does not pay for biologics.
I have spoken with several manufacturers, their assistance plans are all income-based. One would have to qualify for a state welfare plan to receive any manufacture’s assistance. We do not qualify.
Does anyone have any ideas for me?

Lil Hummingbird Member

Medicare pays for my biologics, and Tricare for life picks up the difference. Who told you that Medicare won't pay?
Wallace007 Member

Medicare, my rheumatologist, my pharmacy, and the people with the Enbrel biologic told me.
Medicare is my primary insurance, and I have a medicare supplement.

I do not have a commercial policy. If i had a commercial insurance,
Like Tricare or Blue Cross/Blue Shield, or some other commercial insurance … then i would have no problem.

I am happy you have a commercial policy from your employer or perhaps a spouse’s employer.
Best wishes—-
1. Mary Lynn Member
  
  , I am not yet 65 and haven't had to face this challenge. I will share what I learned from my cousin. He is 65 and has Axial Spondyloarthritis.
  He had been on Humira for awhile but, of course, once he started Medicare, the out of pocket cost was too high. He is able to get Simponi Aria as long as the injections are given at the clinic.
  Just passing this on. I think there is hope but I bet its frustrating.
Wallace007 Member

Thank you for the information. I sill read up on Simponi Aria.
I appreciate you taking the time to write it means a lot. You can certainly tell your cousin I understand. I have only met one other person who had this disease.
Take care
christine.laaksonen Community Admin

Hello , I'm so sorry you're dealing with this. There does seem to be a gap in affordability for treatment, especially for those on Medicare. We do have an article with some information on managing costs that I'll share with you here, https://psoriatic-arthritis.com/resources-cost. I'm not sure if any of it is applicable for you, but I wanted to share it just in case. As Mary Lynn mentioned, I have heard from a few others that they were able to get their biologic covered if the injection was done at the clinic. I really hope there is a way to get this figured out for you so that you can get some treatment and relief! Sending you gentle hugs. -- Warmly, Christine (Team Member)