I apologize in advance for this long post but I heard a question raised by a patient during the recent 2025 Medicare update/changes presentation given by Healthtree and wanted to share what I know about Revlimed coverage in 2025 Medicare Part D plans. As many of you may know, the brand Revlimed has been removed from many (most?) Medicare D plan formularies because a generic (Lenalidomide) is available. I don't see any plan which is covering Revlimed in 2025 -at least not in my geographic area. They are covering Lenalidomide. The issue is that there are exclusivity patents and availability challenges. The exclusivity patent for Revlimed's use for MM maintenance after ASCT expired 2/22/24, however, Lenalidomide is just not available in my state. Small shipments are received sporadically from time to time. The market doesn't have enough Lenalidomide so this is a challenge nation-wide. In 2024, I had my January denial overturned and an exception was granted by the plan for 2024 because they had just removed Revlimed from their formulary in December (after I selected the plan). I argued successfully that this was unfair. This won't work in 2025 since I have no choice than to accept a plan which clearly states Revlimed is not covered. Note: Health plans will update their formularies throughout the year so one month a drug can be covered and the next it is not (or vise versa). This is so unfair to patients! I called the pharmacist this morning to ask about this (I can't afford to pay the $360,000 for Revlimed out-of pocket next year). Their process is to do a pre-authorization for patients. They have been successful in getting Medicare D plans to cover Revlimed by exception. For those plans which still refuse to cover it, they save any Lenalidomide they receive for these patients. Some plans are easier to deal with than others (she is prohibited in sharing this information as to not steer me to a particular plan). Here is information I pulled off of the Medicare web site: "For formulary exceptions, the prescriber's supporting statement must indicate that the non-formulary drug is necessary for treating an enrollee's condition because all covered Part D drugs on any tier would not be as effective or would have adverse effects, the number of doses under a dose restriction has been or is likely to be less effective, or the alternative(s) listed on the formulary or required to be used in accordance with step therapy has(have) been or is(are) likely to be less effective or have adverse effects." The pharmacist at my facility states that potentially they could have more Lenalidomide available in 2025. They are not sure given dependence on just a couple of suppliers. This is what I understand. I hope this information is helpful. Please check with your pharmacy/provider to understand their process for getting Revlimed covered if Lenalidomide is not available in your area.