Any Medicare experts here?

[4speedy]

Can anyone help me understand a Medicare issue?

My mom needs to start taking a post-chemo maintenance drug.  The cost is roughly $17,000 per month, her portion would be $1700 per month.  She does not qualify for patient assistance programs due to her income being too high (Retired teacher pension plus SocSec).  She is balking at paying that much.  The specialty pharmacists has told me that there is a new law that just went into effect that will cap her payment for cancer drugs at roughly $3000 per year so she would really only pay the $1700 for the first 2 months, which she could do.  Can anyone verify this?  From what I have have looked up, it seems like this is part of the inflation reduction act but does not take effect until Jan 2025.  Am I misunderstanding something or is there different legislation that took effect this year?

Also, to make it CE&P relevant, my mom is super bootstrappy and a Trumper who is always complaining about how her hard earned tax dollars are paying for welfare queens to sit at home.  If anyone can point me to the legislation that will be paying for her medication, I will make sure to inform her that she is receiving more than she pays out.  And I will also let her know that programs like this are among the first things the R’s want to cut if they win in Nov.

[seeyalater52]

I suggest calling the American Cancer Society line to see if they have more info. They answer a lot of drug coverage questions and should be able to answer about different types of insurance coverage and other financial options. I can see if I can track down the legislation you’re referencing but I don’t work on Medicare so it isn’t ringing a bell. I’ll phone a friend.

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[AAM2012]

Does she just have part A and B?

[Bad Dingo]

This might be helpful: www.kff.org/medicare/issue-brief/changes-to-medicare-part-d-in-2024-and-2025-under-the-inflation-reduction-act-and-how-enrollees-will-benefit/

She can also reach out to the manufacturer to see about getting her portion waived or look into generics or biosimilars if available.