Does Medicare Cover Aubagio?

Roger Clayton

Founder at - Medins Coverage

Introducing Roger Clayton, a healthcare maestro with two decades of unparalleled experience in medical insurance. As the visionary behind Medinscoverage, Roger's mission is to demystify...Read more

If you or a loved one has been diagnosed with multiple sclerosis (MS), you may be wondering if Medicare covers the medication Aubagio. MS is a chronic disease that affects the central nervous system, and Aubagio is a medication that has been approved by the FDA to treat relapsing forms of MS. Understanding what Medicare covers can be confusing, but we’re here to help simplify the process.

In this article, we will explore whether Medicare covers Aubagio, what the costs may be, and how to navigate the process of getting your medication covered. By the end of this article, you will have a better understanding of what to expect when it comes to getting Aubagio covered by Medicare.

Does Medicare Cover Aubagio?

If you have been diagnosed with multiple sclerosis (MS), you may be prescribed Aubagio as part of your treatment plan. Aubagio is a medication that helps to reduce the immune system’s attack on the central nervous system. However, you may be wondering if Medicare covers the cost of this drug. In this article, we will explore whether Aubagio is covered by Medicare and what you need to know about getting coverage.

Understanding Multiple Sclerosis

Multiple sclerosis is a chronic disease of the central nervous system that affects millions of people worldwide. Symptoms can vary from person to person and can include muscle weakness, difficulty with coordination, and problems with vision and speech. There is no cure for MS, but treatments can help manage symptoms and slow the progression of the disease. Aubagio is one such treatment option that is commonly prescribed to people with MS.

How Does Aubagio Work?

Aubagio works by reducing the number of immune cells that attack the central nervous system. This helps to reduce inflammation and prevent damage to the nerve cells. By slowing down the progression of MS, Aubagio can help improve quality of life for people with this condition.

Is Aubagio Covered by Medicare?

The good news is that Aubagio is covered by Medicare, but there are some things you need to know. Medicare Part D covers prescription drugs, including Aubagio. However, your out-of-pocket costs may vary depending on the specific plan you have. To get the most comprehensive coverage, it’s important to choose a plan that covers all the medications you need, including Aubagio.

How to Get Coverage for Aubagio

To get coverage for Aubagio through Medicare, you will need to enroll in a Medicare Part D plan. You can do this during open enrollment, which runs from October 15th to December 7th each year. During this time, you can compare plans and choose the one that best fits your needs. You can also enroll in a plan outside of open enrollment if you experience a qualifying life event, such as moving to a new state or losing your health insurance coverage.

How Much Will You Pay for Aubagio?

The cost of Aubagio will depend on your specific plan and whether you have reached your deductible. You may also be responsible for paying a copayment or coinsurance for each prescription. However, there are ways to save money on your medications, such as using generic drugs or applying for financial assistance programs. Your healthcare provider or pharmacist can help you explore these options and find the most affordable way to get the treatment you need.

Benefits of Using Aubagio

Aubagio has many benefits for people with MS, including:

– Slowing down the progression of the disease
– Reducing the number of relapses
– Improving overall quality of life

By taking Aubagio as prescribed, you can help manage your symptoms and prevent further damage to your central nervous system.

Aubagio vs. Other MS Medications

There are many different medications available to treat MS, and each one works in a slightly different way. Aubagio is an oral medication, which means it is taken by mouth. Other medications, such as interferons and glatiramer acetate, are given by injection. Some people may prefer the convenience of taking a pill, while others may prefer the peace of mind that comes with a monthly injection. Your healthcare provider can help you decide which medication is right for you based on your individual needs and preferences.

Side Effects of Aubagio

Like all medications, Aubagio can cause side effects. The most common side effects include:

– Hair loss
– Diarrhea
– Nausea
– Increased risk of infections

In rare cases, Aubagio may cause more serious side effects, such as liver problems or a decreased white blood cell count. Be sure to talk to your healthcare provider about any concerns you have about taking this medication.

Conclusion

Aubagio is an effective treatment option for people with MS, and it is covered by Medicare. By enrolling in a Medicare Part D plan and choosing a comprehensive coverage option, you can ensure that you have access to the medications you need to manage your symptoms and improve your quality of life. Talk to your healthcare provider or pharmacist today to learn more about Aubagio and how it can help you manage your MS.

Frequently Asked Questions

Medicare is a federal health insurance program that provides coverage to people who are 65 years or older, younger people with disabilities, and people with End-Stage Renal Disease. Aubagio is a prescription medication that is used to treat multiple sclerosis. Here are some frequently asked questions about whether Medicare covers Aubagio.

Question 1: Does Medicare cover Aubagio?

Yes, Medicare Part D prescription drug plans cover Aubagio if it is medically necessary and prescribed by a doctor. However, coverage may vary depending on the plan you have chosen. It is important to check with your plan provider to determine the details of your coverage. If you are enrolled in Medicare Advantage, your coverage may also vary depending on the plan you have chosen.

It is important to note that if you are eligible for Extra Help, a Medicare program that helps people with limited income and resources pay for prescription drugs, you may have lower out-of-pocket costs for Aubagio. You can contact your plan provider or Medicare to determine if you are eligible for Extra Help.

Question 2: What are the out-of-pocket costs for Aubagio with Medicare?

The out-of-pocket costs for Aubagio with Medicare will depend on the plan you have chosen. Generally, you will have to pay a monthly premium, an annual deductible, and a share of the cost of the medication. Depending on your plan, you may also have to pay a copayment or coinsurance for each prescription. If you are eligible for Extra Help, your out-of-pocket costs may be lower.

To determine the cost of Aubagio with your specific plan, you can contact your plan provider or use the Medicare Plan Finder tool on the Medicare website.

Question 3: Are there any restrictions on the use of Aubagio with Medicare?

There may be restrictions on the use of Aubagio with Medicare. For example, your doctor may need to submit a prior authorization request to Medicare to demonstrate that the medication is medically necessary for your specific condition. Additionally, Medicare may limit the quantity of Aubagio that can be prescribed at one time or require you to try other treatments before approving coverage for Aubagio.

It is important to work with your doctor and plan provider to determine if there are any restrictions that apply to your specific situation.

Question 4: Can I switch Medicare plans if my current plan does not cover Aubagio?

Yes, you can switch Medicare plans during the annual enrollment period, which is typically from October 15 to December 7 each year. During this time, you can choose a new Medicare Part D or Medicare Advantage plan that covers Aubagio. It is important to compare plans to ensure that you choose one that meets your specific needs and covers your medications.

If you experience a special circumstance, such as moving to a new area or losing your current coverage, you may be eligible for a special enrollment period outside of the annual enrollment period.

Question 5: What should I do if my Aubagio prescription is not covered by Medicare?

If your Aubagio prescription is not covered by Medicare, you can talk to your doctor about alternative treatments or medications that may be covered by your plan. You can also appeal the decision by contacting Medicare or your plan provider and providing additional information to demonstrate that Aubagio is medically necessary for your specific condition.

If you are still unable to obtain coverage for Aubagio, you may be eligible for patient assistance programs offered by the manufacturer or other organizations. Your doctor or pharmacist can provide more information about these programs.

What You Need to Know About Aubagio®

In conclusion, Medicare coverage for Aubagio largely depends on several factors such as the type of plan you have, the severity of your condition, and your specific circumstances. It is important to note that Medicare Advantage plans may offer more comprehensive coverage for Aubagio compared to Original Medicare.

Therefore, it is crucial to carefully review your specific Medicare plan and speak to your healthcare provider to determine the level of coverage you can expect for Aubagio. You may also consider exploring alternative coverage options such as supplemental insurance or patient assistance programs to help with the cost of your medication.

Overall, while Medicare coverage for Aubagio may vary, it is important to prioritize your health and work with your healthcare team to find the best treatment plan for your individual needs.

Roger ClaytonFounder at - Medins Coverage

Introducing Roger Clayton, a healthcare maestro with two decades of unparalleled experience in medical insurance. As the visionary behind Medinscoverage, Roger's mission is to demystify the labyrinth of healthcare coverage, empowering individuals to make well-informed decisions about their well-being. His profound industry knowledge has been the cornerstone in crafting the website's exhaustive resources, offering users indispensable guidance and tools for their healthcare needs.

More Posts