(Guest Lecture) Federal, Private and Prescription Legislative Changes You Need to Know

Today's topic is going to be federal legislative and prescription changes that you need to know. And new and upcoming changes are coming to Medicare and traditional health insurance coverage and benefits may affect your treatment. Additionally, the cost of health care services and how you access them may be changing. And Diane is here to review those changes with us today and help us understand what's coming in the future so that we can be better prepared as a MyOloma community. Diana is the financial program manager who specializes in financial health for multiple MyOloma and AML patients. As a professional financial consultant or advisor, excuse me, and former caregiver of her husband who was diagnosed with multiple MyOloma, Diana perfectly understands the financial issues facing multiple MyOloma patients and other cancer patients as well. With that being said, Diana, thank you for being here today and we look forward to your presentation. Oh, I think you're muted, Diana. That might help. Okay, I was like, is she here? There you are. Thanks. And as usual, everything slows off your tongue so effortlessly. This is going to be a very, very complicated and we're going to go through it rather fast because I would like to have opportunity for you to speak or ask questions at the end. And one thing I need everybody to understand that all these changes are not in effect now. They are going to be over a period of time. And hopefully, if there's another administration comes in, those things will not go back. So, so this is what we're going to go through. The federal administrative changes that will impact your wallet, understand how drugs are priced, very important. Changes to prescription costs that are going to be going forward over the next five, six, seven, ten years. Hopefully, it'll go on forever and even get better. Options for expense coverage, preparing for changes and talking to your health care team. Next slide. So this is something a lot of people don't understand how drugs are priced in the United States. And our, it's really frightening. I think we have the best, we consider ourselves the best health care system. And when you really are in the health care system, you realize just how flawed it is. But drug companies pricing is relatively unregulated. Consequently, they often raise costs beyond inflation prices and we know inflation today is unbelievable. This leads to drug companies increasing revenues continually, even if the demand for one or more drugs is not high. That is the way they make money. In a recession or inflationary periods, drug companies do not lose money. When pricing a drug, pharmaceutical companies consider the following things. Cost of the research and development, the competition that's out there. And that's why they try to keep people from coming in and doing biosimilars very often, because they can price those brand name drugs. The drug uniqueness, how effective it is as well. The ultimate goal of pharmaceutical companies when pricing drugs is to generate the most revenue. That is the key thing to understand when you're going to the pharmacy to pick up your drugs. There is, we're going to go through Medicare quite a bit here because this is the area that's going to be really most impacted by these changes. So let's go through this. There's a deductible stage. It's $505 in 2003 that you must pay before insurance begins to do anything. And that's very much like your insurance deductible. You're responsible for 100% of your prescription costs out of pocket until that $505 is met. Very much like deductibles, I said, in requirements in health insurance. The initial coverage stage after you've did that $505, the amount of your co-payments and co-insurance now comes into play. So you'll pay your share your prescription costs according to your prescription plan. And then the part plan D that you have will pay for the rest. Now remember when you pick up your part D plan, that is a standalone plan and your Medicare program. If the combined amount you and your drug plan plan pay for your prescription reaches $4,660 in 2023. And some of you may have already met that if you have these high cost of insurance of prescriptions, then you will enter the part D coverage gap. Now this coverage gap is going to be very interesting because it's going to go into a catastrophic phase. Diana, sorry to interrupt you. Do you have your microphone close to you? It's kind of hard to hear. Is this any better? I'm not sure. We'll see with the audience. I can always put the headphones on if that makes it easier. Okay. I'll do that. Just give me just one second. Yep, that's fine. We'll try that. All right. All right. Let's see. Okay. Is this any better? Audrey, can you hear? Is this any better? Yeah, I'll wait for our audience to tell us. Did you make sure that it's connected to the... Here, we'll stop sharing. Did you make sure that it's connected to your earphones? So when you click the arrow by your microphone, did you select the earphones? I've never had to select the earphones. It usually automatically does that. If our audience could give us feedback on how well they're able to hear, that would be helpful to me. Okay. I think there's been no change since you put them on. I don't think it connected to them. So no change. It's okay. Let's just keep going. You will receive a recording of this and just make sure your computer audios are as high as they can go. I'm not sure what's happening. Thanks for your feedback, everyone. Okay. So the initial coverage stage, the amount of a co-payments and co-insurance will come into play after you've paid that $505 in 2023. You'll pay just your share of the prescription costs according to your plan, and then a plan will pick up the rest. If the combined amount you and your drug plan pay for the prescription reaches $4,660 in this year, you will then enter Part D coverage gap. Now, I've spoken to a lot of patients so far this year, and a lot of those people go into the first one or two months, they are now in that Part D coverage gap, which can be quite frightening. So let's go on and see how this Part D coverage gap goes. This is Part 3. This is that scary, frightening donut hole. And this is supposed to be going away, slowly but surely. This means there is a temporary limit on the amount the drug plan will pay for your covered drugs. Not everyone will enter the coverage gap. It doesn't apply to members who get extra help to pay for their Part D costs, so they don't have to worry about it. Once you are in that coverage gap, you will not have to pay more than 25% of the cost for your brand name and your generic prescription drugs covered by Part D plan. That's biosimilars and the like. And the full cost of these drugs will be used to move you closer to the catastrophic phase, in addition to other things that we're going to point out later. So this is going to get you closer to the catastrophic phase, which means you will pay even less. In 2023, once you spent $7,400 out of pocket, that you have paid out of pocket, you are out of the coverage gap and now into the catastrophic phase. Some people wish they get in there sooner than later, because then for the rest of the year, they're going to be paying a less amount for their prescription cost. Out of pocket. Next slide. So what counts towards your coverage gap? That's your phase three. Your yearly deductible, your co-insurance, and your co-payments. The discount you get on brand name drugs in the coverage gap, and what you pay in the coverage gap. All of that, it counts towards your coverage gap. And that moves you closer to the catastrophic phase. What does not count in that coverage gap? Your drug plan premiums, the pharmacy dispensing fees, and what you pay for drugs that are not covered by your particular plan. Anything that's not covered by your plan is outside of anything that's going to be happening with you. Next slide. So the catastrophic phase. In this phase, you will pay only a small co-insurance amount or co-payment for the covered drugs. Very important to point that out for the rest of the plan year. So in 2025, remember this is 2023, there's time before a lot of these changes come into place, there will be a new manufacturer discount program in Medicare. Now this new program will require drug manufacturers to pay discounts on certain brand name drugs and other types of drugs called biologics and biosimilars. Biosimilars are generics. Both in the initial coverage phase, it is in the initial coverage phase, it's going to be 10%. And in the catastrophic phase, there's a 25% discount in that phase on your brand names, biologics and biosimilar drugs. Next slide. So in 2025, there will be a new manufacturer discount program in Medicare that we just covered. The new program will require those to 10% and 20%, but in addition, government reinsurance in the catastrophic phase will decrease from 80% to 20% for most name brand drugs, biologics and biosimilars, and decrease from 80% to 40% for generics. Currently Medicare pays 80% of the drug spending incurred by Part D enrollees with drug spending above the catastrophic coverage threshold. So with all of these changes coming into play, you should see a overall less out of pocket that you're going to have to pay because of these requirements. And for the high cost drugs or maybe some Medicare will now be negotiating prices on some of those drugs. Next slide. So here's the timeline for that prescription drug provision and the Inflation Reduction Act of 2023. It requires drug companies to pay rebates if drugs price rise faster than inflation. Well, that's kind of questionable because right now inflation for drugs to rise for there to be a rebate on that is kind of high because the inflation rate is extremely high. That means the drug prices have to rise a lot higher than they are right now. Limit installation cost sharing to $35 per month in Part D and Part D, Part B and Part D. So if you're in, it's given to you in hospital or doctor's office versus when you buy it from a pharmacy. It reduces cost and improves coverage for adult vaccines in Part D, Medicaid and CHIP. This is very important. It used to not be in front of mind when we're talking about vaccines and the cost of that, except, as you know, the last two years with COVID and the vaccines and the cost for that and the controversy as to who's going to pay for ongoing vaccines. I don't know if this is ever going to go away. Probably it's going to be part of our healthcare landscape for the vaccines. So it's very important to understand how the cost of vaccines are going to be going forward. Next slide. In 2024, this new change eliminates 5% co-insurance for Part D catastrophic coverage. That's huge because now it's going to be a smaller amount that you're going to have to pay when you get into that catastrophic phase. It expands eligibility for Part D low income subsidy full benefits up to 100% of federal poverty level. And we're going to have a link for that for you to understand what those federal poverty levels are. And in 2024 through 2030, it limits Medicare Part D premium growth to no more than 6% per year. Now we know every year it's been going up, but it cannot go up more than 6%. So if it's $100, it's $6 per $100. So just for you to understand that. Next slide. In 2025, it adds $22,000 out of pocket cap in Part D and other drug benefit changes. That is not in 2023, not in 2024, but in 2025. In 2026 through 2029, it will implement negotiated prices for certain high cost drugs. They're in the process now of looking at some of those drugs that will be included. And for a lot of you are going to be disappointed. Revlimit will probably 99.9% will not be included in that because of some of the criteria for those drugs to be negotiated. Part of that is you cannot have a biosimilar. We know Revlimit now have a biosimilar even though the price of that is not very much lower than the actual brand name. In 2026, there will be 10 Medicare Part D drugs that will be chosen for that in 2027. Additional 15 Medicare Part D drugs will be in there and they have pushed this rule from 2027 all the way out to 2032. So that means those things are going to go into effect pulling more drugs up until 2032. Now, again, as we know when there's a new administration in, a lot of times there are fights to overrun or overrule things that have been done previously. We don't know what that's going to mean. So I would encourage you to keep up with what's going on with Medicare Part D, particularly if you're going to find some changes in your treatment, it's going to be even more expensive. Next slide. In 2028, there'll be additional 15 Medicare Part B and Part D drugs that will be included in this price negotiation. In 2029, there will be 20 Medicare Part B and Part D drugs. Companies that refuse to negotiate with Medicare will face a 95% tax penalty on that drug, and they are not going to want to have this tax penalty. It's very costly to those pharmaceutical companies. Next slide. So there are two policies of Inflation Reduction Act. One requires the federal government to negotiate process prices for some high cost drugs covered under Medicare that we just went through. These include brand name and biologic drugs without generic or biosimilar equivalents under Medicare Part D, that would include your reference, unfortunately, or the retail prescription drugs or Part B administered by physicians. Those are among the highest spending Medicare covered drugs and are nine or more years, small molecular drugs, or 13 or more years, biologicals from FDA approval are eligible for negotiation. And some of these drugs they're looking at have already been looked at for the last eight or nine years and have already been saying they're going to approve those small molecular drugs for price negotiation. The number of people who will see lower out of pocket drug costs under this provision and the amount they'll save is going to depend on several things. The number of people with Medicare who use those drugs and the price reduction achieved through the negotiation process. So a lot of this is up in the air. We probably won't know about it just like you don't know what the changes are going to happen with Medicare are going to be pretty much last minute. So I would keep an eye out on what's going on with that. Next slide. Relative to the prices that would have been applied in the absence of the new law. It requires drug manufacturers to pay rebates to Medicare, if they increase price. Increase prices should not be processed faster than inflation. Right now inflation is really high for drugs used by Medicare beneficiaries so keep an eye on what's going on with inflation, keep an eye on what drugs are going to be approved in here soon, and those will affect in 2025. This provision could have spillover effects for people with private insurance, if it results as lower process growth for drugs covered by private insurance and here's something I want you to be aware of. Majority what we're talking about today is talking about Medicare Part D with those changes. And whenever there's a change in one side there's generally a change or price for change on the other side so private insurance through your employers, there may be some changes in that we don't know what those changes will be. They could be, they may start reacting to the lower prices on the Medicare side, or they may not so I would keep an eye and keep an ear close to what's going on if you are still in private care, private insurance and maybe changing over, hopefully to Medicare with the additional processes they have will have an effect that's going to reduce your out of pockets. Next slide. So this caps again the Medicare beneficiaries out of pocket spending under the Medicare Part D benefit, first by eliminating the co insurance above the catastrophic threshold in 2024. And then by adding a $2,000 cap on spending in 2025. It also limits annual increase in Part D premiums from 2024 to 2030 capping out of pocket spending on a Medicare Part D will be especially helpful for beneficiary and officiaries who take high cost prescription drugs for cancers, especially some of those drugs that are, especially those drugs who have no biosimilars and some of the newer drugs that are coming out. Now for example in 2020 among Part D enrollees without low income subsidies who will not fall under that coverage gap, average annual out of pocket spending for the cancer drug revlimit was $6,200 used by 33,000 at that time beneficiaries. Next slide. The cost sharing for adult vaccines under Medicare Part D in 2023 is eliminated, and there is also improved access to adult vaccines. And we're talking about earlier, under Medicaid and ship the children's health employer protection program shingles is unfortunately common for the elderly, and for people who are have lower immune systems. I know myeloma is one of those if you're taking a cycle beer, it is a drug that actually helps if you end up with with with shingles it reduces the severity of it in 2020 4.1 million beneficiaries received a vaccine covered under Part D including the shingles Vaccine coverage is optional and varies by state, but I would encourage anyone who has an immune system that's compromised to talk to their, their health care team to find out if they should go in and take that vaccine for shingles, as well as the other vaccines that's something that's very important for you to be aware of. 25 states to not cover all vaccines and many states impose a cost sharing requirement on adult adult vaccines, making them too costly for low income Medicare beneficiaries so be aware of these changes and find out what can be covered under your insurance plan. Next slide. In 2024 eligibility for full part the low income subsidies were expanded, this will impact beneficiaries with incomes up to 150% of the poverty level. If you see the link on the bottom is this federal poverty level guidelines 2023. I would encourage you all to look at that because this is also important not just for this. If you are looking for financial assistance for your copays out of pocket premiums and you're going through a nonprofit like LLS health tree, healthy health well cancer cares patient advocacy foundation, they are going to refer to those federal poverty guidelines as well as some of the pharmaceutical companies so it'd be a good idea for you to keep up with those things. Those guidelines do change every year so keep up on that as well. Beneficiaries receiving. Okay. This will impact beneficiaries with low incomes up to 100% of the poverty and modest assets and appeals, the partial low income of benefit that is currently in place. This is for individuals with incomes between 135% and 150% of the federal poverty level beneficiaries receiving partial low income benefits typically typically pay some portion of party premium, and the standard deductible 15% of co insurance and modest co payments for drugs above the catastrophic threshold beneficiaries receiving full low income payments pay no part the premium or deductible and only pay modest co payments for prescription drugs, until they reach the catastrophic threshold, when they face no cost sharing so it's different for those people who have higher higher incomes, they will have additional cost sharing, even in a catastrophic threshold. Next slide. So this benefit will will this benefit will benefit mostly low income black and Hispanic Medicare beneficiaries in particular because they are more likely than white beneficiaries to have incomes below 100 between 135% and 150% of poverty. And I would include is for not just black and Hispanic is for also rule severely rule areas where they have low access to health care. A lot of people are also in that 135% 150% poverty level, not just black and Hispanics. Next slide. The anti kickback safe harbor protections the inflation reduction act includes a provision that delays the implementation of the Trump administration's drug rebate rule until 2032 rather than taking effect in 2027 that's what I helps. This rule would eliminate the anti kickback safe harbor protection for prescription drug rebates negotiated between drug manufacturers and pharmacy benefit managers or health plan sponsors in Medicare Part D. This rule was estimated to increase Medicare spending and premiums paid by beneficiaries and so that's what they're trying to eliminate and reduce, reduce and eliminate. So here's an area there's, I, I occasionally get calls from people who are now living part time in other parts of the country, other parts of the world. Also, Medicare beneficiaries, or even private care plan members who live in the United States, and they know for the cost of drugs are less expensive than other countries, and they will. I mean, I ask if it's legal possible to get drugs, high cost drugs here in the United States from abroad. It's interesting but the cost of our drugs, even for revel in it and some of the things that are that are made in countries outside the United States are still less expensive to get in other companies, countries. I mean, sometimes over 1000% less expensive than in our country so there's an ongoing debate in the government as well as states provide additional lower cost drugs for abroad, we know that's been going on for a while, it will continue. where the current law stands in terms of getting your prescribed cancer drugs from other countries. Now you probably take notes on this because if you travel a lot or you're outside the country for travel or you spend time a lot out of the country you need to know how this works so you won't get caught. Can everyone hear? Yeah. Next slide. So can you go to Canada get your prescriptions for a much lower cost and bring them home? Here are the current laws and regulations regarding this. If you're entering the U.S. with FDA regulated products in personal baggage or sending products by mail or courier from abroad the FDA has rules that governs personal importations. A personal importation is a product not for sale or distribution in the United States commerce. That means it's not FDA approved for our country, it hasn't been hasn't been tested and all that so these products may be carried in baggage or shipped by courier or international mail. The personal importation for U.S. citizens in most circumstances it's illegal to import drugs into the United States for personal use because these products have not been approved by the FDA for use and sale in the United States. Therefore if a drug is approved for use in another country but is an unapproved drug in the United States it is illegal to import. So be aware of that it may have different you got to be aware of how they're labeled countries label things differently and maybe a drug that's approved at FDA but it may be labeled completely different it looks different because every country and state has the way they have to have these things labeled so be aware of how that works as well. Next slide. So when can you import an unapproved drug to the United States? The product is not for treatment of a serious condition and there is no known significant health risk and this is over-the-counter drugs not prescription drugs. The product is for the treatment of a serious condition prescription drug products the product is for a serious condition for which effective treatment may not be available in the United States either through commercial or clinical means there is no known commercialization or promotion of the product persons living in of the product for persons living in the United States and the product does not represent an unreasonable risk. So how do you determine all these things? Well you need to talk to your doctor you need to contact the FDA to get approval or you have to have this documented if there is a question about anything you're going to be importing or bringing back to the United States. Next slide. The consumer affirms in writing that the product is for personal use but we can write anything but once you get to that border they're going to question that and good luck on that. The quantity is generally not more than a three month supply so you must provide the name and address of the doctor licensed unit in the United States who is responsible for your treatment they're going to be signing off that you have access to this product and they approve of it. You must provide evidence that the product is for the use continued for the continuation of a treatment begun in a foreign country. Let's say you were you lived in Mexico half the time and you got an illness there and they started treating you there but their medication is different from what we have here and you're coming back to the United States for the following six years you need to have proof that is the medication that the doctor approved for you to use in Mexico so that you can bring that product back to the United States. Documentation, documentation, documentation, protect yourself. Next slide. A foreign national is any person who is not a citizen or permanent resident of the United States so if you're traveling to United States for vacation, attending school, or travel for work the federal drug administration will allow you to bring with you your personal medications while you are in the United States. You can also ship a 90-day supply of drug products. If staying more than 90 days additional meds can be sent to you. Documentation is required that provide evidence that the medication is being sent for your own personal use while visiting the United States. So for those people who are in school or are here doing additional work or other kind of work that is very important for you to keep up on that because the time to get approval to get the documentation you need can be can delay your treatment so I encourage you to make sure those things are taken care of in an appropriate period of time. If you are a U.S. citizen and live in the United States and travel to other countries be aware of their laws regarding drug importation. Their laws change from country to country it's going to change and so you need to make sure you have the current correct documentation for each country you're going into. Even if you have the drug in your pocket and it has your name on it you need to have verification from your physician that the drug you're using is for your needs and if you need to have an import more if you're out of the country make sure you get all the documentation you need so it won't be hung up taken away from you at the airport or anywhere else. Next slide. If you're a patient that requires a controlled substance in your treatment and is traveling to the United States the Drug Enforcement Agency will generally make the decision on whether controlled substances are allowed to be imported for personal use. Now you need to get on the DEA government website to find out and to call you can also call to find out what the controlled substances are. Controlled substances may be Adderall maybe some of those drugs that you take have been taken for years and don't think of as a controlled substance but you need to be aware of all these things. For those controlled substances to fall under the jurisdiction of both the DEA and FDA the two agencies will coordinate when determining the admissibility of the product which means there's time involved whenever you get into any kind of government area for things to be approved so make sure you give yourself appropriate time to make sure that you're not going to lose have end up with a loss of coverage or a delay in your treatment plan. Again go to DEA.gov if you have any additional questions. Next slide. In summary this is a lot I feel like I just went through it a lot really fast I apologize I'll give you time to ask questions and I encourage you to get the slides and digest it you may find there's going to be additional questions when you go through that and you look at your own insurance plan. I would encourage you all to do that especially if you've picked up a new insurance plan through the Medicare this past year and know what's and be aware of what's going to be going on with your treatment going forward so that you can make changes accordingly in a timely manner and there will be many changes coming that may reduce the cost of your prescription drugs especially for high-cost insulin and cancer drugs they are not all going to be in effect in 2023 2024 they will be ongoing and there will be ongoing additions to the medications that will be approved for the negotiation of prices so keep up on that especially with the new drugs that are coming out for my alumna some of those may be included remember the criteria for those to be included in that negotiation price. Many of the changes will not take effect immediately Ken will be spread over several years many states are as well many states as well as federal administration are doing are doing ongoing reviews regarding the importation of drugs from other countries hopefully some of those things will open up and make it a lot more viable for patients to get prescriptions at a less less cost since many my alumna patients do travel abroad review of the importation of drug products must be adhered to to stay compliant with us laws to keep you out of jail to keep you on your treatment plan it's very important get all your documentation more documentation is better than than less always when it comes to those things I know that was a lot I felt like I just ran through it even though I when I was reading the slides my on my own it's it goes to take forever and ever but gives you time to ask me some questions. Great thank you so much Diana we really appreciate it I know you worked really hard in the content for today and we already have some really great questions so I'm excited to get to them. Robert is asking so the out-of-pocket maximum is capped at $2,000 in 2025 what is the estimated maximum out-of-pocket cost in 2024? Okay a lot of that's going to depend on your insurance plan what is your insurance plan you need to look at your Medicare insurance plan some of them will be 2024 a lot of those things have not come out you know Medicare usually gives a lot of information about what their your costs for your premiums and out-of-pocket calls those usually come out in September, October, September of the year the changes so we'll start seeing some of those changes in October September, October of this year. Awesome thank you this person is wondering about after a stem cell transplant insurance not wanting to cover the cost of a single shingles shot that's a tongue twister because the shots were already given before the stem cell transplant they're not authorizing a different shot and was wondering if you know how they could get reimbursed for that or covered for those kind of shots. Okay so if that was something that was required by your doctor your doctor says I want you to go in and get another single shot that would be an appeal through your insurance your insurance program that you'd have to fill out an appeal process form your doctor a doctor's note will be helpful would you attach it to that appeal form if it is if it is something that your doctor says I really think you should do that that is an appeal process especially if you've already had one done a lot of times they don't replace those single shots single shingle shots are generally one time and you go right as we know of and and if you're doing a second one you know that's why because it's not something that's normal to do. Yeah I would just yeah sometimes they don't want you taking the shingle shots within like a certain time after your stem cell transplant as well so just making sure with your doctor about the timing of the shingle shot and like Diana was saying she did a whole webinar on medical appeals so we can make sure to get that to you guys as part of the follow-up resources that we have we'll make sure that that medical appeals workshop that you did is available for people that might need it. It's very interesting too it's not just a shingles on vaccine but the COVID vaccine you got to be aware of if you've done stem cell transplant, CAR T, any of those things there's going to be a timeline your doctor is going to give you as to when you can get another one of those shots because you or if you've had COVID and you and you want to get the latest shot the booster shot you need to talk to your doctor because there's there you need to be aware of what's going on with your treatment and you don't want to bring something else in that's going to cause you to have any additional problems. Thanks Diana. Paul brings up a great and common question among the myeloma community wants to retire but doesn't know what drugs he might need in the future. How can he get Medicare insurance that will cover future drug needs with Part G? He travels some for his for his treatment. That's a very complicated question because we don't know whenever you get a standalone drug program any drug program you have drugs that fall off those tiers you have the tiers one through five and those those drugs change every year through negotiations with pharmacy benefit managers all this stuff happens and in the future we don't even know what drugs are going to be available to you so it's very difficult to know what's going to be covered. I would encourage you when you find out you know if you know what drugs are coming coming for the following year treatment for the following year you can get on Medicare and find out what they currently cover that doesn't mean it's going to change next year so it's one of those things a lot of people will will choose Medicare plans prescription plans and then they forget about it you know I have coverage but you need to keep up keep on these things every year you need to review it and look at other options every year because drugs will fall off of plans um I can't there's no magic bullet to say what's going to be covered next year two years from now three years from now don't know yeah but it's not common that they stop covering something that's generally widely used no but the cost sharing price might change this is where it's really helpful I think if you want to connect to one of our financial coaches we'll also provide that information for you in the follow-up email or could even type it here if you go to our healthtree.org slash myeloma slash coach you can look specifically for people that have financial expertise that are willing to talk to you for free and kind of talk you through some of these questions finances can be so complicated on top of an incredibly complex disease in myeloma and so we're trying to help you the best we can these questions are are valid and common and unfortunately don't have a solid answer right right um all right so this is clara she is a disabled veteran thank you for your service clara and this scene is smoldering right now so feels pretty covered for drugs that she might need in the future but is wondering how to check that's very similar to the previous yeah so what what you were mentioning that they can look on the website of what drugs are currently covered what is that website and how do they access it we have a um a medicine assistance tool um link or you can go to medicare.gov they have a link as well for you to look at any drugs that you have currently drugs you have or any that you know that are out there whether you're using it now or not to see if they're covered majority of drugs are covered like you said mentioned before audrey at a certain level is what you're going to pay out of pocket depends on what prescription plan you have that includes your employer plan um i don't want to just speak toward um medicare party but it includes people with private insurance as well their prescription plans um whether you have etna or for united health care in a private insurance plan and different levels you can get your out of pockets may change or or out of pocket costs may be different so there are options there are links we have on the coach financial resource pages where you can go in and find out about insurance you can go to um i want to say retire retired aon.gov oh yeah let me we have several links where you can call up and find out about what's covered if you're under medicare and you can of course the private insurance plans change a lot as far as the amount of pocket um okay you have to keep up with that with what's going on with the insurance like i like i said very rarely does a drug fall off completely that is when it falls off completely generally it means it's fda is not going to approve this drug because there's a problem with it and you shouldn't be on that in first you know anymore yeah so i wouldn't worry about coverage it's just what out of pocket you will be responsible for yeah and nancy is saying go to va formulary va has covered all my husband's phylum of drugs so we will i'll put that i i look it looks like i answered it live so you can look and you can find that information the answered section of the questions um or i think it's actually just what you guys see in the q a under answered okay great questions everybody keep them up so fern is wondering when is my when does my out of pocket maximum take effect for palm list i don't know if we can answer that specifically but how do how do they know when their out of pocket maximums been reached based on what on his insurance plan um he has he has i don't i don't know what his insurance plan say i don't know if he's medicare private pay i don't know yeah fern i think this is one of the complicated parts i mean insurance itself is so complicated yeah he can call his insurance plan on his card there should be a telephone number if it's etna or whoever it is they should have called him and tell him what is out of pocket it may even show it on his card um find out what his max out of pocket is going to be if he's concerned about if he's going to meet any of those um phases like the the coverage phase part d or going to the catastrophic phase i mean that we have those numbers on there uh they're referring to medicare okay those numbers are on the slides okay that's out of pockets those are on the slides okay perfect so we'll review these slides or we'll send these slides to you for your review um okay is all medicare part d information applicable to drugs obtained in a medicare advantage plan which is not a standalone prescription plan i'm sorry could you repeat that so basically they're asking um don i think this is what you're asking so if it's not forgive me but or maybe you can clarify but medicare part d information is it part of the medicare advantage plans or is it separate very interesting medicare part d is you is a standalone medicare prescription program you can have medicare part c or your advantage plans that have include prescription plan coverage within that within that program so it's a complete package for medicare part c medicare part d is a standalone medicare prescription program they will all work together because they're all they're all regulated by the federal government it's all opposite so if you're on medicare advantage do you also need to get the medicare part d only if your medicare advantage does not have the part d included in their plan there's different types of medicare advantage programs awesome so please don't think you're getting medicare you're getting medicare part advantage and you automatically have part d you need to make sure it has that and also it can include dental and vision and health um health exercise programs like um where you go and what do you call those memberships for health plans or health clubs some of them have those and memberships and stuff thank you couldn't think of names yet included as well i'm sitting here looking at a treadmill and everything now glenn states that revlimid has been taken off of humana since they are unable to get lenalidomide it is being covered so do you mean glenn i'm not sure if you mean that revlimid the brand has been taken off but lenalidomide because it has a generic is being covered if that's true um give us some clarification there do you know anything about that no i don't it sounds like he's asking because um a lot of generally when you go and get a prescription you have you you have the option to have the brand name with generic and your doctor is ultimately going to come down to say i want them to be on the generic or the brand name and if of insurer is going to say we're not going to cover revlimid because you have linalenomide but linalenomide just because they say that doesn't mean it's available where they are right so it's going to it's going to be a work between you and your doctor um because the doctor often goes say i i need to have them on the brand name because guess what linalenomide may only be what you're approving but it's not we don't have it's not available to us interesting i just uh it just is so frustrating how complicated it is nancy saying i know people who import their routine prescriptions through legitimate canadian pharmacy has that changed or are the rules just not enforced i want this could be a off off um off the record right i would be i would be i would love to know how they are getting them imported depending on what drugs they're getting again if these drugs are fda approved it's the same drug that's being used labeling is almost the same it may have been already checked through um when you go through import import importing drugs then that may be a viable legitimate way to do it but if they're just going over to canada and buying the drug and they may be just squeezing through just be careful when you're squeezing through on that car because somebody may stop you and they may not be in a good mood that day anyway i'm just saying you're you're always putting yourself at risk when you're just buying a drug in a different country and you're bringing it in our country because they have the right to to do searches and you may have you may have a port in your chest saying i look i do have cancer i do okay but that doesn't matter they need to know these drugs are legitimately coming across borders interesting uh tim says great job diana so you referred to a list of drugs that's being negotiated for better pricing as you mentioned between the governor governor government and pharma companies um how many of these do we know what those drugs are how many of them are typically used in myeloma treatment is there a place that we can be looking at what drugs they're they're going back and forth about they are looking at some now they've come up with a couple um and they're not going to let everybody know what those drugs are because some of those things may fall off and change especially if you and they're trying to make sure there's no biosimilars coming out as well during that period of time when this stuff goes into effect so the closer we get to that i will promise you i will get a list of those things out there so everybody will know okay thank you appreciate it we do have a couple more minutes if any of you guys have uh continual questions please take advantage of the resources that um we have i put one of them in the chat which is this uh i i mean i can put it in the chat now i put it in the q a but sometimes it's helpful if i put it in the chat this is where you can look um to look more about your medicare plans and um what's covered things like that the it used to be aon and now it's a light so it's retiree at alight.com um we'll be including that we also have financial resources that are on our website um these are also going into the chat these are helpful you're looking for pharmaceutical um assistance programs or other assistance programs we have basic living expenses child care expenses government assistance things that can help you with costs that are occurring because of the the myeloma in different ways um we also uh have and i hope i'm not overwhelming you with resources um but lots of questions about medications in general we do have this new um medication medications um kind of guide on our website that helps you go through what the different kind of medications are um and what they're how it works how it's administered who should take it who shouldn't take it common side effects commonly being tested with um just in case you have questions about the actual drugs itself in addition to that um some of the pharmaceutical companies have resources available for you to call and ask about the medications and you can get a lot of information from them about again how medication reacts i mean how it reacts with our medications things you should be aware of if you feel if you have side effects or concerns you can call them directly as well and we're i'm in the process of updating that pharmaceutical contact list because some of those things have changed thank you so much all right um bob has a question will revlimid cost be the same regardless of which standalone medicare part d1 has so does the does the cost of revlimid remain the same the revlimid cost is not going to change what's going to change is is you've got to be aware of the max out of pocket what you're going to be concerned about is your max out of pocket for your prescriptions that's what's going to be important i'm like normally like a pretty hopeful excited person and i just think that um as you were saying in the beginning our health care could use a lot of improvements but i know we all know that and there is a lot of resources to help us and we have this information from diana thank you so much um and fern yeah fern reiterated that out of pocket maximum in 2025 will be two thousand dollars lots of two thousand thrown out um out there but um so many people so many people but again um it changes changes of administration could change that is that true you know they try to fight everything every it's yeah it could possibly change okay fingers crossed that it doesn't because it's going to help so many people right because trump had had things going to change in 2027 and then the biden administration came in and pushed it out to 20 2032 so yeah well i'm hopeful i'm hopeful that we can find so that we can find i i know there's been a lot of legislative work recently with trying to make things more affordable and i think those are bipartisan things that are passed and so i just hope we continue to see that um as as that goes forward um bob was saying it would be useful if the u.s had a system like nice in britain i'm not familiar with that but i would love to learn more about it um wonderful i would love to hear if you guys have any more questions i'm going to go through the outro announcements and if there's any more questions when i finish we'll hit those as well you can join us next month on march 7th to talk about what's the role of a financial advisor and how to choose one and remember as you leave the session today we'd love for you to take two to three minutes to fill out that survey tell us what you liked what we can do better next time and what your future topic suggestions for the financial chapter are upcoming events um february 7th that's tonight at 6 p.m pacific is our socal myeloma community chapter we're going to be talking about the art of personalized myeloma treatment the eight that 1 p.m eastern is our non-secretory myeloma community chapter dr faith davies will be joining us to talk about understanding mass spectrometry and how it can be used to help test non-secretory myeloma patients the ninth at 6 30 p.m eastern is our northeast myeloma community and we're going to be talking about mental health how we can focus on it on improving and taking care of our mental health willing to sign up for any of those events and even more events i didn't mention is found at the bottom of the slide and will be included in our follow-up email um lots of people asking for the resources as they can't see them in the chat so let me try to pull those over so we have this one and this one let's see if it's gonna let me um and these are also coming in your follow-up email so these will come to you via email shortly as soon as we have the recording ready we'll be able to send you these along with the recordings so hopefully that can be helpful to you there you go and then fern was wondering again what is that out of pocket maximum for 2024 unfortunately we don't know so that um if i understand correctly dayan and we don't know and we will figure that out hopefully at the ends of this year um and again go back into the into the slides it'll say it's projecting some of the things out and right starting in 2025 but they can look at that awesome thank you so much so again those resources will be sent out to you guys um and we were here to help and those financial coaches that i mentioned are there to help as well so don't forget to connect with them a special thanks again to our community event sponsors bistol my school of gsk jen and tech abby and amgen and a big thank you to each of you for helping us build this financial community we're grateful for your awesome questions and diana for your excellent preparation we appreciate all of you hope you have a great rest of your day thanks everyone