Is Fasenra Covered by Medicare Part B?

If you or someone you love relies on Fasenra to manage asthma symptoms you might be wondering if Medicare Part B covers it We’re here to unpack the details in simple terms so you get a straight answer with no fluff Medicare Advisor Insurance Group LLC specializes in simplifying Medicare coverage questions like this one so let’s dive in

Understanding Fasenra: What is it?

Fasenra is a prescription biologic medication specifically designed to treat severe eosinophilic asthma in adults It’s an injectable drug given by a healthcare provider about once every eight weeks after the initial three doses Every dose aims to reduce asthma attacks and keep breathing smooth

What Sets Fasenra Apart?

1. Targets eosinophils the white blood cells that trigger asthma symptoms
2. Given only once every eight weeks after initial doses
3. Reduces dependency on oral corticosteroids

Fasenra sounds fantastic right? But before we dive into whether Medicare covers it let’s clarify a few things

Medicare Part B Coverage: The Basics

Medicare Part B generally covers outpatient care doctor visits durable medical equipment and some injectable medications that are administered by healthcare providers in a clinical setting This includes certain biologics but not all medications fall under its umbrella

Henry Beltran the owner of Medicare Advisors Insurance Group LLC says “Medicare Part B can be tricky when it comes to covering specialty medications like Fasenra If you get the injection in a hospital or doctor’s office Part B might step in but home injections? Not so much ”

Medicare Part B and Fasenra: Does It Cover This Asthma Treatment?

Here’s the key question Is Fasenra covered by Medicare Part B? Yes and no Part B covers Fasenra but only under specific conditions

When Medicare Part B Covers Fasenra

1. Administered in a Doctor’s Office: Since Fasenra is injected by a healthcare provider Medicare Part B is more likely to cover it if you receive the injection in a clinical setting
2. Medically Necessary: Medicare will only cover treatments deemed medically necessary by your healthcare provider

When Medicare Part B Won’t Cover Fasenra

• Self-Administration: Medicare Part B doesn’t cover Fasenra if it’s administered at home by the patient
• Out-of-Pocket Deductibles: Medicare Part B includes annual deductibles and coinsurance payments which means you may still have to pay a portion of the cost

Henry’s Insight

“Fasenra coverage is a bit like trying to get your cat to sit still during bath time” jokes Beltran “You have to meet some specific conditions to get Medicare Part B to pay for it otherwise they leave you high and dry ”

How Medicare Part D Fits into the Picture

If you’re determined to get Fasenra at home Medicare Part D may be your answer This part of Medicare often covers prescription medications you take yourself but here’s the twist Part D plans vary widely and each plan decides which drugs they cover and the amount they cover So if you’re set on having the convenience of home injections Part D could help but it requires thorough research

Drawbacks to Relying on Part D for Fasenra Coverage

• Higher Monthly Premiums: Medicare Part D plans might cost more every month
• Formulary Limitations: Not all Part D plans cover Fasenra so you’d have to find a plan that includes it
• Out-of-Pocket Costs: Even with coverage you might face copayments and other costs

Beltran adds “I tell my clients all the time ‘Do the research Compare your Part D options closely because not all plans are Fasenra-friendly”

Navigating Potential Costs of Fasenra with Medicare

Let’s break down the potential out-of-pocket costs so you know what to expect when working with Medicare to cover Fasenra

Medicare Part B Costs

1. Annual Deductible: The annual deductible for Part B in 2024 is around $233 which you’ll need to pay out-of-pocket before Medicare kicks in
2. 20% Coinsurance: After meeting your deductible Medicare Part B typically covers 80% of the approved cost of Fasenra injections you’ll need to cover the remaining 20%
3. Doctor’s Fees: If the injection occurs in a doctor’s office additional facility fees may apply

Medicare Part D Costs

1. Monthly Premiums: Expect to pay a monthly premium that can vary widely based on the plan
2. Copays or Coinsurance: Depending on your specific Part D plan you’ll likely have to pay a copay or coinsurance for Fasenra
3. Coverage Gap (“Donut Hole”): Many Part D plans have a coverage gap meaning higher costs for medications after you reach a certain spending limit

“Let’s be real about it Medicare costs can feel like a roller coaster You’re either in for a smooth ride or a wild loop-de-loop” Beltran shares with a grin

Tips to Save on Fasenra with Medicare

If you’re feeling the pinch on your wallet here are a few ways to reduce out-of-pocket expenses on Fasenra

• Check for Manufacturer Coupons: Some drug manufacturers offer financial assistance programs
• Seek Out State and Local Assistance Programs: Depending on where you live there may be additional programs to help cover high medication costs
• Ask Your Doctor about Alternatives: While Fasenra is effective there may be other medications with lower costs

Final Thoughts from Henry Beltran

“Listen Medicare’s coverage of Fasenra is not exactly straightforward I always tell folks that understanding their plan and knowing their options is crucial ” Beltran states “If you need help reach out Don’t navigate this alone we’re here to make Medicare easy to understand ”

Frequently Asked Questions

Does Fasenra Fall Under Medicare Part B or Part D?

• It depends Part B covers Fasenra only when administered in a clinical setting by a healthcare provider Part D might cover it if you’re administering it at home

Why Doesn’t Medicare Cover Home Administration Under Part B?

Medicare Part B is designed to cover treatments given in a medical facility not self-administered medications which fall under Part D

Can I Use Both Medicare Part B and Part D for Fasenra?

It’s one or the other Part B covers Fasenra in a clinical setting while Part D covers medications taken at home

What Are Other Treatment Options for Eosinophilic Asthma?

Your doctor can advise on alternatives if Fasenra isn’t covered or affordable Keep in mind other biologics might have similar coverage challenges with Medicare

####### How Can I Get Help Navigating Medicare for Fasenra?

Give us a call here at Medicare Advisors Insurance Group LLC We’ll review your plan answer questions and make this Medicare journey feel less daunting

The Bottom Line

While Medicare Part B may cover Fasenra in specific cases it’s not a blanket rule Medicare Part D may also help but with its own limitations and costs If you’re still uncertain feel free to reach out to Medicare Advisors Insurance Group LLC for personal assistance

Medicare Advisors Insurance Group LLC is ready to help clarify what Medicare may cover and ensure you’re well-informed