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Posted On: 11/13/2019 1:09:39 PM
Post# of 148899
Why the sub q will be great for medicare patients!
Forgive me if we have discussed this, but I recently discovered something that bodes well for leronlimab on the revenue front. My father has metastatic bladder cancer that has spread to his lungs. He is now on Keytruda and will likely be on that for a few years, he has a high PDL1 score so the doctors opted to use only Keytruda and not a combo. I have been helping my mom navigate the Medicare world for my father and with discounts the yearly patient cost will be about 14,000 after discounts, not including the doctor costs for the IV visit. IF the Oncologist opted for a immunotherapy combo the yearly cost would be about 30,000 out of pocket. No prescription plan covers immunotherapy because it is done IV at a doctors office so it is viewed as a medical procedure. As many are aware Medicare is an 80/20 plan. Prescription drugs are very different and many times much cheaper as they have different coverage then drugs administered by a doctor. After speaking with a Medicare specialist at length the coverage comes down to whether a treatment can be done at home, if so it falls under the prescription coverage which has much better coverage than the medical procedure side of Medicare. This is huge from a cost perspective for patients when make decisions with their family. Thought I would share.
https://www.medicare.gov/drug-coverage-part-d...verage-gap
Forgive me if we have discussed this, but I recently discovered something that bodes well for leronlimab on the revenue front. My father has metastatic bladder cancer that has spread to his lungs. He is now on Keytruda and will likely be on that for a few years, he has a high PDL1 score so the doctors opted to use only Keytruda and not a combo. I have been helping my mom navigate the Medicare world for my father and with discounts the yearly patient cost will be about 14,000 after discounts, not including the doctor costs for the IV visit. IF the Oncologist opted for a immunotherapy combo the yearly cost would be about 30,000 out of pocket. No prescription plan covers immunotherapy because it is done IV at a doctors office so it is viewed as a medical procedure. As many are aware Medicare is an 80/20 plan. Prescription drugs are very different and many times much cheaper as they have different coverage then drugs administered by a doctor. After speaking with a Medicare specialist at length the coverage comes down to whether a treatment can be done at home, if so it falls under the prescription coverage which has much better coverage than the medical procedure side of Medicare. This is huge from a cost perspective for patients when make decisions with their family. Thought I would share.
https://www.medicare.gov/drug-coverage-part-d...verage-gap
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