Monday, March 28, 2011

Medicare Potholes to Avoid

Thinking that your coverage won't change? Think again! Yesterday’s Chicago Tribune ran a very informative article, Be sure to steer clear of those Medicare potholes. It’s well worth your time to read this article especially if you are nearing Medicare eligibility. Did you know that you can be hit with a big lifetime financial penalty if you miss your Part B enrollment period?

Are you currently being treated for a chronic disease with an off-label drug? The FDA allows physicians to prescribe approved medications for other than their intended indications and that’s called off-label use. Unfortunately, Medicare won’t cover off-label drugs.

This could happen to you. Here’s an excerpt from the article:

When Charles Sowell retired about five years ago after a career with a major manufacturer, he left with a pension and retiree health benefits.

When he turned 65 in August and transitioned to Medicare, however, he got hit by a major surprise.

The Chico, Texas, resident has suffered from hives since a 1990 bout with cancer and an autoimmune disease. In 2005, his doctor prescribed a medication typically used to treat asthma, Xolair, for the hives. It worked, keeping him virtually symptom-free.

But early this year he had to quit receiving Xolair injections because Medicare hadn't approved them for that purpose. Without coverage, the medication costs about $1,600 and needs to be repeated every four weeks, Sowell said. That's nearly $21,000 a year.

"That's a big expense that wasn't in our overall financial plan" for retirement, Sowell said.

While appealing his case to Medicare for coverage of the drug, he has been substituting another drug that has made him gain 20 pounds and leaves him breathless after even mild exertion.

"It's maddening to know there's something that can take care of me, but I can't use it," he said.

Baker and other senior advocates say they are heartened by a recent favorable decision in a New York federal court and the reintroduction of legislation calling for wider acceptance of off-label prescription drugs for patients under Medicare's Part D drug benefit.

Sowell, meanwhile, plans to continue his appeals to Medicare, despite a wave of cost-cutting sentiment in the country.

"In my job, I used to review government contracts and dealt with a lot of bureaucracy, so I'm probably more persistent than the average person," he said. "I'm going to stick with this and see it through."

Please write congress in support of this bipartisan bill: H.R.5732 - Part D Off-Label Prescription Parity Act

WASHINGTON -- Representative Mac Thornberry (R-Clarendon) is looking to help Medicare patients. He introduced the bipartisan "Part D Off-Label Prescription Drug Parity Act" last week. If passed, Medicare Part D carriers could cover "off label" use of drugs prescribed to people living with chronic diseases when its use is supported by experts. Rep. Thornberry says as of now, many Medicare participants with serious conditions lack access to safe and effective medications under Part D.


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