SPRYCEL® (dasatinib) Medicare Part D Reimbursement
SPRYCEL is an oral medication covered by Medicare Part D
Medicare Part D is a voluntary prescription drug benefit for Medicare patients that went into effect on January 1, 2006. Individuals who are enrolled in Medicare Part A or B are eligible to enroll in Medicare Part D. To receive this benefit, a person with Medicare must enroll in a stand-alone Prescription Drug Plan (PDP) or Medicare Advantage plan with prescription drug coverage (MA-PD). While these prescription drug plans are approved and regulated by the Medicare program, they are designed and administered by many different private health insurance companies, so coverage may vary significantly from plan to plan.
Medigap is a supplemental coverage available only as part of Medicare Part A and B program. Some people elect to purchase Medigap to help pay for the cost-sharing expense that is part of Medicare Parts A and B.
Coverage gaps
All Medicare prescription drug plans (Part D) impose cost-sharing expenses on their plan members, in addition to the premiums that are paid. Cost-sharing expense takes a number of forms, including deductibles, co-insurance, and a coverage gap that is commonly known as the “doughnut hole.” After satisfying all of a member’s deductible and doughnut hole expense, and some co-insurance expense, the member receives coverage at a higher level, often 95% of the cost of drug services. This benefit level is attained after the member has paid $4,350 out of pocket for drug costs in the 2009 calendar year.
To learn more about Medicare coverage, see “Bridging the coverage gap,” a printable brochure available at the Medicare Website1.
Reference:
1. Bridging the coverage gap. Available at: http://search.cms.hhs.gov/search?
q=catastrophic+coverage&client=medicare_frontend&proxystylesheet=medicare_frontend
&output=xml_no_dtd&numgm=5&site=medicare_collection&sa.x=33&sa.y=4..
Accessed November, 2009.
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