Dec. 15, 2018

As we move into 2019 we may find that our patients are eligible for more technology and less expensive medications.

Over the past few days I have been receiving ads on my Facebook page for the Dexcom 5 and 6 and Medicare coverage. Since my wife has been using mealtime and correction insulin  and is on Medicare this is great news. In the past 3 months she has also gotten information on pumps from Medtronic and patches from V-go in the mail.

This has all happened without her requesting a single thing. The big question will be the cost. Hopefully it will be reasonable enough everyone can afford the supplies.

Insulin will also be cheaper in 2019. Sanofi started it with their guaranteed pricing of $90 cash for a vial of insulin and $150 for a box of pens. Lilly has joined the act with a decreased pricing program as well.

For those patients who are on Medicare, insulin is not a problem for many until they reach the donut hole, and this year it will be easier to get thru the donut hole as the new federal budget increases the amount that manufacturers have to pay towards your patient’s donut hole from 63% to 75%.  Once these patients reach the catastrophic coverage portion a box of insulin pens will cost the Medicare patient between $6 and $25.

There is also a movement afoot for manufacturers to sell directly to patients through dedicated dispensaries, cutting out the PBM’s and the wholesalers, allowing lower direct cost; and finally, some of the PBM’s are offering to share the rebates that Pharma pays to the PBM directly to the patients when they pick up their prescriptions. Considering at times rebates can be as much as 80%, if only half is passed to the patient, drugs will get much cheaper.

Here’s to hoping that all this takes place and we can all feel more comfortable that our patients will get the medications we want them to use.

*****************************

We can make a difference!

*****************************

Dave Joffe

Editor-in-chief