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Post Medicare Drugs

Posted on 4/25/23 at 5:24 pm
Posted by RB5
Member since Aug 2021
135 posts
Posted on 4/25/23 at 5:24 pm
Pre-Medicare my wife’s Ozempic medicine for her diabetes was free with our company insurance. Now that we are Medicare age, the cost is outrageous. In January I had to pay our annual $500 deductible. Then it was $13/mo after that. That is until May, when we hit the ‘donut hole’. Now it’s $1300/mo. I’m pretty well off and I can’t afford it. This is insanity that once your Medicare age, some drugs that you need for a healthy lifestyle are no longer affordable. Am I missing something?
Posted by OysterPoBoy
City of St. George
Member since Jul 2013
34974 posts
Posted on 4/25/23 at 5:58 pm to
quote:

when we hit the ‘donut hole’


I never really understood that. How much do you have to pay before you reach the other side?
Posted by Big Scrub TX
Member since Dec 2013
33315 posts
Posted on 4/25/23 at 6:54 pm to
quote:

Now it’s $1300/mo. I’m pretty well off and I can’t afford it. This is insanity that once your Medicare age, some drugs that you need for a healthy lifestyle are no longer affordable. Am I missing something?
You can definitely attempt to reverse her out of diabetes for way less than that per month.

LINK
Posted by BigPerm30
Member since Aug 2011
25846 posts
Posted on 4/25/23 at 7:09 pm to
Curious as to how long has she been on the jab and how much weight has she lost?

quote:

I’m pretty well off and I can’t afford it.


Also, how does this work? Was it a typo?
Posted by RB5
Member since Aug 2021
135 posts
Posted on 4/25/23 at 7:58 pm to
I’m not paying $1300/mo, no matter how well off I am. That number is ridiculous imo.
Posted by hob
Member since Dec 2017
2126 posts
Posted on 4/26/23 at 8:04 am to
quote:

You can definitely attempt to reverse her out of diabetes for way less than that per month.

LINK


Let me summarize Virta Health.

Eat clean keto with macros of 30 total carbs/day and protein of 119 grams/day.

They provide a meter that reads both glucose and ketones (it's a private labeled keto mojo meter). They want you in nutritional ketosis to burn fat rather than carbs.

You get a health coach to consult with and provide support.
Posted by Lawyered
The Sip
Member since Oct 2016
29208 posts
Posted on 4/26/23 at 8:53 am to
quote:

How much do you have to pay before you reach the other side?


It’s plan specific . Could be $500… could be $3-4,000. No real rhyme or reason to it . And often nobody ever explains this part upon signing up for plans .

I hate it . And I always get bitched at for it in the pharmacy as to why I jacked up blanches’ insulin pens from $8.35 to $750. ( it’s not my decision.. and then I bring up the magic phrase “donut hole” and the people act like I have 3 heads. Then I get to explain that to them)
This post was edited on 4/26/23 at 8:53 am
Posted by TigerGrl73
Nola
Member since Jan 2004
21270 posts
Posted on 4/26/23 at 4:41 pm to
You should be paying 25% of the cost when you are in the coverage gap until catastrophic coverage begins. I don't know how much Ozempic is, but $1300 seems really high if that's 25%.
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