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Employer insurance to Medicare and drug coverage

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2 months 1 week ago #73681 by ccas60
Employer insurance to Medicare and drug coverage was created by ccas60
I will be going on Medicare in 2025 and currently my ITP Rx, Doptelet, is covered thru Sobi Patient CoPay at 100% because I have retiree health insurance through my former employer (commercial insurance). It is my understanding that once a patient has governmental health insurance (Medicare, Medicaid) that patient assistance is no longer available from Sobi. If anyone has gone through this transition, could you please share your experience and advice?

As we all know, our medications are necessary and expensive. I’m guessing there is a copay but I’m concerned about the cost. The Medicare formulary I checked stated that Doptelet is a Tier 3 drug.

Thank you in advance! I hope everyone’s ITP journey is going well and your platelet counts are in healthy ranges.

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  • midwest6708
  • Offline
  • ~ Janet ~ Diagnosed Sept. 2008
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2 months 6 days ago - 2 months 6 days ago #73684 by midwest6708
Replied by midwest6708 on topic Employer insurance to Medicare and drug coverage
Your reimbursement is determined by the Medicare Part D (drug) and/or supplemental plan of your choice. Benefits and co-pays vary. My supplemental plan sets ITP oral drug co-pays at $80 per month. The NPlate I take is considered a medical "treatment" covered by Part B, and is completely covered that way. I advise you to compare the benefits of several Part D insurance providers before you lock into one. Consult a Medicare supplement broker if it's all as overwhelming to you as it would be to me. At one time, I recall that some pharmacies provided such advice as a free service; but they all seem to be suffering from short- staffing these days. Not sure if they're able to do that anymore.

Hope this helps!

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2 months 2 days ago #73693 by ccas60
Replied by ccas60 on topic Employer insurance to Medicare and drug coverage
Thank you for this information! I’m feeling overwhelmed with all the choices of Medicare and how Part D will cover this medication. I hope whatever way it will be covered that it will be affordable. I’m just grateful it’s been covered at 100% thus far… a real blessing! Be well!

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The Platelet Disorder Support Association does not provide medical advice or endorse any medication, vitamins or herbs. The information contained herein is not intended nor implied to be a substitute for professional medical advice and is provided for educational purposes only. Always seek the advice of your physician or other qualified healthcare provider before starting any new treatment, discontinuing an existing treatment and to discuss any questions you may have regarding your unique medical condition.


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