Medicare expands tier pricing system

Full story: USA Today

Medicare's drug benefit, expanding on a practice now in limited use in the private sector, requires patients to pay larger co-payments for expensive treatments, including some drugs for cancer, arthritis, ...
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1 - 20 of 21 Comments Last updated Nov 18, 2012
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Vicki Lea

United States

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#1
Mar 8, 2006
 
I have Medicare D along with Secure Horizon. I was put on Enbrel in June of 99 for my rare inflammatory muscle disease Polymyositis. I also have Pulmonary Fibrosis caused by the inflammation associated by the Polymyositis. I have two forms of Arthritis as well. When Medicare D came into affect the copay of Enbrel jumped to $400 per month. I'm only on SSD and can ill afford the cost of the drug. Since getting off of Enbrel I'm now back on Oxygen 24/7 and my last Pulmonary Function tests show that I've lost 50% of my breathing capacity in three months. I spend most of my time in bed as it's very difficult to move around. The other drugs that I have to use for my diseases do not do the trick and some of the other stronger drugs I can't tolerate. Enbrel was the drug that gave me back my life. I've tried to find funding for the copay for Enbrel but all of the funding companies no long fund for off label use. If I had RA I could get funding but I have something much worse and I can't get funding. I'm very disappointed in how they structured the drugs and they have hit the people who are not poor enough to apply for medicaid and not rich enough to pay for the copay. Most of us that have a chronic disease don't want to use these very expensive drugs but have already tried the others without them helping. Medicare and the insurance companies have really put the chronic disease patients in the worst possible position. Many will no longer have a life of there own and many will die from there decision. I've worked all my life and now when I need help the most, I feel I'm being punished for working all those years.

Thank you
Constance Steffen

Oklahoma City, OK

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#2
Mar 15, 2006
 
Vicki Lea wrote:
I have Medicare D along with Secure Horizon. I was put on Enbrel in June of 99 for my rare inflammatory muscle disease Polymyositis. I also have Pulmonary Fibrosis caused by the inflammation associated by the Polymyositis. I have two forms of Arthritis as well. When Medicare D came into affect the copay of Enbrel jumped to $400 per month. I'm only on SSD and can ill afford the cost of the drug. Since getting off of Enbrel I'm now back on Oxygen 24/7 and my last Pulmonary Function tests show that I've lost 50% of my breathing capacity in three months. I spend most of my time in bed as it's very difficult to move around. The other drugs that I have to use for my diseases do not do the trick and some of the other stronger drugs I can't tolerate. Enbrel was the drug that gave me back my life. I've tried to find funding for the copay for Enbrel but all of the funding companies no long fund for off label use. If I had RA I could get funding but I have something much worse and I can't get funding. I'm very disappointed in how they structured the drugs and they have hit the people who are not poor enough to apply for medicaid and not rich enough to pay for the copay. Most of us that have a chronic disease don't want to use these very expensive drugs but have already tried the others without them helping. Medicare and the insurance companies have really put the chronic disease patients in the worst possible position. Many will no longer have a life of there own and many will die from there decision. I've worked all my life and now when I need help the most, I feel I'm being punished for working all those years.

Thank you
Vickie,

I am very sorry to hear about your problem, I am happy to see that someone else has the same problem that we do. My husband has MS and social security says we make too much money because I still work. My husband worked for 27 years as a printer and several other jobs and paid into our great system and now we like you can not get the help we need to have a quality life. We can not get any credit because of the many hospital bills, he was in the hospital five times last year and twice this year, we know the staff by name, now that is sad. We are on your side and we will say a prayer for you. I know that people are fast to say that but we do mean it and if we find out any information that can help we will post it. In the mean while please try this web site www.ppary.org and see if there are any companies that can help you there, just list the drugs you take and it will list the companies that can help. I hopes this works for you. Good luck and God speed- Al and Connie Evans
Frank

Iowa City, IA

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#3
Mar 16, 2006
 
When I was put on enbrel 18 months ago, the people at the rheumatology clinic said that the price aught to come down soon. Ha, I wonder if that will ever happen.
paul lenihan

Leavenworth, KS

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#4
Apr 2, 2006
 
Will enbrel ever come to a reasonable cost so the average person can afford it? It has kept my severe psoriasis under contol for the past 9 months but but the copay since i retired has gone up to $318. I cannot afford thia any longer than 3 months. Is there any help out there for relief.
sherri zook

United States

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#5
Apr 6, 2006
 
i have fibromyalgia degenerative disc disease exposed scietic nerve high boold pressure high cholestrol and suffer from depression. they have put me on new drugsthat i cannot afford i haven't worked since 2001 have applied for diaiability am still waiting need help paying for medicine. i take rozerm 8mg
crestor 5mg
cymbalta 60 mg
acceon 8 mg
cholorzoxazone 500 mg 3times
please help me if you can or let me know of someone that might be able to help me thank you sherri zook
pat payan

AOL

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#6
Apr 12, 2006
 
i would like to know if i qualify for any low or assisted type of programs. if possible, can you please send me any information. t39hank you
Chris

State College, PA

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#7
Apr 19, 2006
 
Try to get in at NIH study program if you are accepted into the study they send your Enbrel to you.
LyAnn Williams

AOL

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#8
May 24, 2006
 
my mother has secure horizon,she has to pay for all her medicines and a co pay each time she sees a doctor she is a patient of gould medical .2yrs ago she lost her husband.recently she was diagnoised with chronic kidney disease,congestive heart failure,chronic colon cancer,she's a diabetic,and has to take insulin.also high blood pressure,2 months ago she had a stroke.the prices of medications,the doctors have her taken cost to much and the dr continue switching her medicines week to week.one week she will pay $127.00 or less and the following week they tell her stop taking that one an give her another costing her more...she is currently taking 10 differant medicines an over 10 others in the last month she was prescribed an no longer on. how does a widower on a fixed income aford her medications and fight to live when she must choose witch medicines she can afford that month ...she's 74 years old and her golden years should be loved cared for in comfort not like this .....
her

Holden, MA

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#9
Jun 4, 2006
 
My wife has scleraderma,+ RA + OA
HAVE ANY SCLERODERMA SUFFERERS TRIED ENBREL or HUMERA ?????

My heart goes out to all of you chronic disease suffers,
especially those of us who cal ill afford the high cost
of our required medications.

Jenette3

United States

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#11
Nov 4, 2006
 
LyAnn Williams wrote:
my mother has secure horizon,she has to pay for all her medicines and a co pay each time she sees a doctor she is a patient of gould medical .2yrs ago she lost her husband.recently she was diagnoised with chronic kidney disease,congestive heart failure,chronic colon cancer,she's a diabetic,and has to take insulin.also high blood pressure,2 months ago she had a stroke.the prices of medications,the doctors have her taken cost to much and the dr continue switching her medicines week to week.one week she will pay $127.00 or less and the following week they tell her stop taking that one an give her another costing her more...she is currently taking 10 differant medicines an over 10 others in the last month she was prescribed an no longer on. how does a widower on a fixed income aford her medications and fight to live when she must choose witch medicines she can afford that month ...she's 74 years old and her golden years should be loved cared for in comfort not like this .....
This may sound really strange to you, but..here goes. If your mother is of sound mind, maybe she could adopt your kids or her grandkids.then...depending on finances...she would qualify for medicaid, they cover prescriptions. In the alternative, did you know that is possible to adopt your own mother?
Jenette3

United States

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#12
Nov 4, 2006
 
her wrote:
My wife has scleraderma,+ RA + OA
HAVE ANY SCLERODERMA SUFFERERS TRIED ENBREL or HUMERA ?????
My heart goes out to all of you chronic disease suffers,
especially those of us who cal ill afford the high cost
of our required medications.
This is not legal advice... but if I were in your position I would definitely consult an attorney for legal advice. The same rules that work for our beloved government...work for us also! Please see my next comment.
Jenette3

United States

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#13
Nov 4, 2006
 
I hate prefacing this but I have to, THIS IS NOT LEGAL ADVICE. If your mother is legally incompetent you should be able to adopt her. Again, in the alternative, maybe another family member could "adopt" her. Yes,...legally,...formally, just like a child.
myself

New Orleans, LA

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#14
Nov 5, 2006
 
It would be nice to have some sort of insurance. I have a very serious form of RA that doesn't allow me to work outside the home. We run a home business which my husband runs on his own these days. With this home business, we cannot afford insurance and the cost of doctor visits for blood tests each month and medication comes to around $500 or more each month and that doesn't include biologic medication which I definately cannot afford to receive.

I have tried all sorts of medications and have had allergic reactions. I found one last one that works but if it stops at any time, I can't afford the biologic drugs so i will be having so much trouble just trying to live.

Plus, being in my low 30s, getting medicare is almost impossible to achieve.

Just makes me wonder if anything is ever going to change. Getting medical for my family is over $500 a month, put that on top of everything i already pay and we just can't make it.
Martha

Fredericksburg, VA

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#15
Feb 13, 2007
 
There are many of us affected by the high costs of prescriptions drugs, specifically Enbrel. As an Enbrel user due to RA, I was hoping to find out how others are coping with the high cost of this excellent drug, including co-pays, but also to find out which Medicare Part D programs have been most helpful. I will be eligible for Medicare Part B and D in July due to disability status. Right now I'm researching how to get help in paying for the Enbrel because my COBRA coverage is exhausted and due to incorrect information given to me by a Social Security field office employee, I am without any insurance at all until July--I have appealed to received Medicare Part B now but of course it takes a very long time to get a response from a government agency. And, because I have Medicare Part A, no private insurance company will insure me!
Brigitte Fayyad

Los Angeles, CA

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#16
Mar 6, 2008
 
bottom line, our whole healthcare system sucks.
lcarter

Arraiján, Panama

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#17
Mar 13, 2008
 
Sorry for the poliitical comment, but I am angry and very upset for each of you!!! I read your stories and it makes me feel so very sad to think that one of the most wealthy contries in the world, full of good people (who frequently vote against their own best interest), does not include Health Care as one of it's basic human rights. It seems unethical to me the way that the American Medical and especially Pharm. Associations continually snow the American people by perpetuating the myth that National Health Care is bad. I am praying that something is done very soon to change our current health care system where only the rich can afford to get needed first rate medicines or top notch medical care. We middle class deserve better! I agree, our whole health care system sucks in the US!
MS Father

Vancouver, WA

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#18
Mar 19, 2008
 
The people that are governed by the government the people pay for are morally entitled to the same level of healthcare as the people elected to govern us. Anything less is cause for peaceful revolution. If the people we elect to rule us are not willing to ensure all people are treated equally, then we must vote them out.
duane

Sun City, AZ

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#19
Apr 9, 2008
 
Hello:
Has anyone found a health insurance company that will fill the gap from Cobra to Medicare as I'm retired with SA age 61 and running out of Cobra. So far no luck trying to find major medical health insurance.
duane

Sun City, AZ

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#20
Apr 9, 2008
 
Sorry I meant to say I had Psoriatic Arthritis
clint

Maryville, TN

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#22
Oct 19, 2010
 
why is everything so outdated

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