With open enrollment for Medicare now underway, people living with psoriasis who are securing or adjusting their coverage may want to factor biologics into their coverage plan. Such was the guidance from dermatologist Dr. Jerry Bagel, a board member of the National Psoriasis Foundation (NPF), during a recent NPF webinar on biologics and Medicare Part B coverage.
During the webinar, Dr. Bagel — also director of the Psoriasis Treatment Center of New Jersey — discussed the effectiveness of biologic drugs for treating psoriasis and how they can be covered by Medicare Part B insurance.
Typically used for moderate to severe psoriasis, biologics are administered through an injection or IV infusion at a doctor’s office or clinic. As such, they are classified as medical care and will often be covered under Medicare Part B. Most other prescription medications that are administered outside of a medical setting are considered for coverage by Medicare Part D insurance.
Below are some tips from Dr. Bagel for navigating Medicare Part B biologic coverage.
People living in the United States who are 65 or older are eligible for Medicare, which can help cover the costs of biologic treatment for psoriasis. People can enroll in a Medicare insurance plan when they turn 65 or during the open enrollment period, which is Oct. 15 through Dec. 7 of each year. Dr. Bagel advised that people consult Medicare.gov for additional enrollment information and instructions. “If you have Medicare Part B, you could pay little to no cost for your biologic medication,” he said.
Dr. Bagel encouraged people living with psoriasis to ask prospective dermatologists if they typically prescribe biologics and whether they have a biologics coordinator on staff. A biologics coordinator is someone who advocates for people taking biologics when negotiating with insurance companies. “They are essential,” said Dr. Bagel.
Working with a medical team that has a biologics coordinator on staff will help a person get insurance coverage for biologic medications and reduce one’s out-of-pocket costs, Dr. Bagel explained.
Although Medicare Part B insurance provides coverage for most biologics, a person may still want to consider enrolling in a secondary insurance plan. A secondary insurance plan provides additional coverage alongside a primary plan. Therefore, in case Medicare will not cover the cost of a biologic treatment, a secondary insurance plan may cover it — or at least some of the remaining cost. Examples of insurance plans secondary to Medicare include commercial plans, Veterans Affairs benefits, and employer-based plans.
People who are under 65 and do not qualify for Medicare may be eligible for financial assistance from certain biologic manufacturers. More information about these options is available on specific drug and treatment websites.