Medicare Coverage & COPD

By twovillages

1 min read

I've needed to use prednisone more often, and my pulmonologist recently saw me and reviewed what inhalers I've been on. He feels Dulera will be beneficial and says to discontinue the Symbicort and Advair. The problem is Medicare doesn't cover it, and it would be $600.00, or more a month. At times I've paid over $5,000 a year just for inhalers, and my monthly Medicare premium is over $500.00. Add that the cost of the Medicare Advantage plan payments, plus a tax of $65.00 a month extra because of income.

I found out today that my doctor was able to get the Dulera approved for a year. It will get me to the donut hole much more quickly, and probably will continue to cost me hundreds out of pocket, BUT I'm so relieved I get a chance to try this drug to see if it helps keep me as active as I can be. Yea!!!

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Leon Lebowitz, RRT Member
Hi <inline-mention username="twovillages" user-id="2403860"/> - thanks for sharing this experience of yours with the community. I know there has been considerable discussion(s) in our community about the imposing costs of medication, Medicare, medical insurance, the 'donut hole', approved medications (versus those not covered), and physician input. This is a very timely and current example of how one person is managing and, we appreciate your candor. Glad to hear your doctor was able to 'go to bat' for you and get the Dulera approved. Please do check back and let us know how you are doing using this medication (Dulera), instead of the Symbicort and Advair. Once again, thanks your input and feedback here. Warmly, Leon (site moderator <a href='https://copd.net' target='_blank'>COPD.net</a>)
mj Member
If you are medicare age medication in a nebulizer cup is covered. Have you tried Perforomist and Budesinide? Used with a 6 month BAN Aeroclipse neb cup and a nebulizer machine that puts out no less than 35 PSI. This is what my patients are on when they can't afford inhalers.
1. mj Member
 I test patients machines all the time. My pharmacy carries the ones I want which put out 40 PSI. 
2. Leon Lebowitz, RRT Member
 <inline-mention username="mj" user-id="2452709"/> Hi again, mj, and thanks for responding. We appreciate your comments. I am a respiratory therapist, too - we are in the same profession!! Leon (site moderator <a href='https://copd.net' target='_blank'>COPD.net</a>)
twovillages Member
Leon, I messed up. It's Trelegy I switched to about three weeks ago. I don't seem to be as SOB, which has cut down the severe anxiety connected to that. I used to have to find a spot to sit down frequently, and struggle to pierce mouth breath. That was with bad weather days. I seem to cough up more gunk in the morning. I have a rescue inhaler I can use 4 times a day. My doctor didn't want me using the 20 mg prednisone for five days once a month as I had been so he scheduled an office visit that resulted in the inhaler change. I haven't used pred for a couple months now. It seems so silly to fight this sometimes.
1. Lyn Harper, MPA, BSRT, RRT, AE-C Moderator
 <inline-mention username="twovillages" user-id="2403860"/> Trelegy has become a popular choice (for good reason) among pulmonologists for their patients with COPD. The fact that it combines three different medications into what we refer to as "Triple Therapy" is a great thing. For people like yourself, it can get them completely off an oral dose of prednisone. I hope it continues to work for you! Lyn (site moderator <a href='https://copd.net' target='_blank'>COPD.net</a>)
2. Leon Lebowitz, RRT Member
 <inline-mention username="twovillages" user-id="2403860"/> Hi again, twovillages, and thanks for making the correction - now it's much more understandable how you were treated at the doctor's office. I see my colleague, <inline-mention username="Lyn Harper, RRT" user-id="2449585"/>, has already responded and, I concur with all she's said. Now that you are on Trelegy, it's great to hear it has been so effective for you in just three weeks! You must be so relieved to be feeling better and also to be off the oral steroids, too! Once again, we appreciate both your input and your feedback. Keep up the good work! All the best, Leon (site moderator <a href='https://copd.net' target='_blank'>COPD.net</a>)
dittohio Member
I’m sorry, this is not re-story! I was wondering how I can see a message I sent a week or so ago. Thank you so much!
1. Leon Lebowitz, RRT Member
 <inline-mention username="dittohio" user-id="4197349"/> Hi dittohio and thanks for your post. I was able to go to your profile (the part that I can see as a moderator). Here I can see you joined the community on July 8, 2021, and this is the sole post from you to date. However, if you are referring to 'messages', you'll have to go to your profile yourself. There, at the 'drop down', you will see 'private messages'. This will reflect all the messages you have written (including the one from last week). Then, if you click on 'my profile', you will see 'my activity'. There you will see ALL your activity on the community website since you joined. I hope this is relatively clear, and simple, for you to accomplish. If you have any difficulty at all, please just reach out to our site leads at 'contact@COPD.net'. The leads will be able to assist you, including setting you up with our tech folks, if necessary. How does this sound? Leon (site moderator COPD.net)