Good morning BlueSky,

Medicare Part D (Prescription) does not cover specialty drugs well. We have an $8000 per year out-of-pocket expense, once you reach the $8000 you qualify for the catastrophic phase of part D which will then cover medications at 100 percent. I'm having the same issues with medications, too expensive for me so I go without them. An infusion is considered a procedure, this is covered by Medicare and your Supplemental Plan. Medicare Part D is changing in 2025. Your out-of-pocket expense will be $2000 per year. The Part D plans will be more expensive next year.

Thank you Tonda for responding. I would love to continue my self administered injections as opposed to getting infusions but I am beginning to understand that I am probably out of options. I sure wish something could be done about this.

The problem with the supplemental D coverage is that the tiers seem to be different than the ones that were with your normal insurance coverage. I take Savella for fibro and it went from being very cheap to being over $200/.month. We were able to appeal, but it is still about 3 times what I had been paying. My husband was on Otezla and with the discount card from the company we paid about $50 per month. It went to over $12,000.00 initial deductible so we had to find an alternative. Now he gets injections (stelara) in the doctor's office to the tune of about $13,000 every 3 months, and it is completely covered by Medicare and out supplemental F coverage. It goes under major medical instead of pharmacy. The other issue is that once you're on Medicare you no long qualify for the drug company's discount cards.
So, you might talk to your rheumy about changing your RA meds (especially the biologics) to something that is covered under major medical and not pharmacy.