Does Medicare Cover Benlysta?

As we age, the likelihood of developing chronic illnesses and diseases increases. It is no secret that medical treatment can be expensive and can quickly drain a person’s savings. This is why programs like Medicare exist to help seniors pay for their healthcare expenses. However, not all medications are covered by Medicare, which can leave many people wondering whether or not their treatment options are covered. One such medication is Benlysta, a drug used to treat lupus. In this article, we will explore whether or not Medicare covers Benlysta and what options are available for those who need this medication.

Benlysta is a relatively new drug that has shown promising results in the treatment of lupus, an autoimmune disease that affects millions of people worldwide. While this medication is effective, it can be quite costly, and many people are left wondering if they can afford it. For those who rely on Medicare for their medical care, the question of whether or not it covers Benlysta is a pressing one. In this article, we will delve into the details of what Medicare covers and whether or not Benlysta is included in those coverage options.

Does Medicare Cover Benlysta?

Benlysta is a prescription medication used for the treatment of lupus. Lupus is a chronic autoimmune disease that causes inflammation and pain in various parts of the body. Benlysta is an effective treatment for lupus and is covered by Medicare. In this article, we will discuss in detail the coverage of Benlysta under Medicare.

What is Benlysta?

Benlysta is a medication used for the treatment of lupus. It is an intravenous medication that works by targeting B cells, which are responsible for producing antibodies that attack healthy cells in the body. Benlysta helps to reduce inflammation and pain, and improve overall quality of life for those who suffer from lupus.

How does Benlysta work?

Benlysta works by targeting B cells, which are responsible for producing antibodies that attack healthy cells in the body. By targeting B cells, Benlysta helps to reduce inflammation and pain, and improve overall quality of life for those who suffer from lupus.

What are the benefits of Benlysta?

The benefits of Benlysta include reducing inflammation and pain, and improving overall quality of life for those who suffer from lupus. It is an effective treatment for lupus and can help to reduce symptoms such as fatigue, joint pain, and skin rashes.

Does Medicare cover Benlysta?

Yes, Medicare covers Benlysta. However, it is important to note that the coverage of Benlysta under Medicare may vary depending on the individual’s plan.

What are the different parts of Medicare?

Medicare is divided into several parts, including Part A, Part B, Part C, and Part D. Part A covers hospital stays, while Part B covers doctor visits and outpatient services. Part C is also known as Medicare Advantage, which is a combination of Parts A and B, and may include additional benefits such as prescription drug coverage. Part D covers prescription drugs.

How is Benlysta covered under Medicare?

Benlysta is covered under Medicare Part B, which covers doctor visits and outpatient services. However, it is important to note that there may be out-of-pocket costs associated with Benlysta under Medicare Part B, such as copayments and deductibles.

Does Medicare Advantage cover Benlysta?

Medicare Advantage plans may cover Benlysta, but the coverage may vary depending on the individual’s plan. It is important to check with your Medicare Advantage plan to determine the coverage of Benlysta.

How much does Benlysta cost?

The cost of Benlysta may vary depending on the individual’s insurance plan and coverage. However, the average cost of Benlysta is around $35,000 per year.

Are there any cost assistance programs available for Benlysta?

Yes, there are cost assistance programs available for Benlysta. The manufacturer of Benlysta offers a patient assistance program to help individuals with the cost of the medication. Additionally, Medicare may offer assistance for those who qualify.

Benlysta vs other lupus medications

There are other medications available for the treatment of lupus, such as Plaquenil and Imuran. However, Benlysta is a newer medication that has been shown to be more effective in reducing lupus symptoms.

What are the differences between Benlysta and Plaquenil?

Plaquenil is an oral medication that is used for the treatment of lupus. It works by reducing inflammation and pain. However, Benlysta is an intravenous medication that targets B cells, which are responsible for producing antibodies that attack healthy cells in the body. Benlysta has been shown to be more effective in reducing lupus symptoms compared to Plaquenil.

What are the differences between Benlysta and Imuran?

Imuran is an oral medication that is used for the treatment of lupus. It works by suppressing the immune system. However, Benlysta targets B cells, which are responsible for producing antibodies that attack healthy cells in the body. Benlysta has been shown to be more effective in reducing lupus symptoms compared to Imuran.

Conclusion

In conclusion, Benlysta is an effective medication for the treatment of lupus and is covered under Medicare. However, the coverage of Benlysta under Medicare may vary depending on the individual’s plan. It is important to check with your insurance provider to determine the coverage of Benlysta. Additionally, there are cost assistance programs available for Benlysta for those who qualify.

Frequently Asked Questions

Does Medicare Cover Benlysta?

Yes, Medicare Part B may cover Benlysta if it is used to treat active Systemic Lupus Erythematosus (SLE) in adult patients who meet certain criteria. Benlysta is administered as an intravenous infusion, and it is usually given in a healthcare provider’s office or clinic.

It is important to note that Medicare coverage for Benlysta may vary depending on the specific insurance plan and the patient’s eligibility. Patients should speak with their healthcare provider or Medicare representative to confirm coverage and eligibility for this medication.

What are the Criteria for Medicare Coverage of Benlysta?

To be eligible for Medicare coverage of Benlysta, a patient must have active SLE and meet certain clinical criteria. The patient must also have tried and failed other treatments for SLE, such as corticosteroids, immunosuppressants, and antimalarials.

Additionally, the patient must receive Benlysta as an intravenous infusion in a healthcare provider’s office or clinic, and the provider must be enrolled in Medicare. Patients should speak with their healthcare provider or Medicare representative to confirm eligibility for coverage.

What is the Cost of Benlysta with Medicare Coverage?

The cost of Benlysta with Medicare coverage will depend on the patient’s specific insurance plan and eligibility. Medicare Part B will typically cover 80% of the cost of Benlysta, and the patient will be responsible for the remaining 20% as well as any deductible or coinsurance amounts.

Patients should speak with their healthcare provider or Medicare representative to confirm their out-of-pocket costs for Benlysta with Medicare coverage.

What are the Side Effects of Benlysta?

Like all medications, Benlysta can cause side effects in some patients. Common side effects of Benlysta include nausea, diarrhea, fever, chills, and fatigue.

In rare cases, Benlysta may cause more serious side effects such as severe allergic reactions, infections, and changes in mental health. Patients should speak with their healthcare provider if they experience any concerning side effects while taking Benlysta.

Can I Receive Benlysta at Home with Medicare Coverage?

While Benlysta is typically administered as an intravenous infusion in a healthcare provider’s office or clinic, some patients may be eligible to receive Benlysta at home with Medicare coverage. This may depend on the patient’s specific insurance plan and eligibility.

Patients should speak with their healthcare provider or Medicare representative to confirm their eligibility for at-home administration of Benlysta and to discuss the potential benefits and risks of this option.

In conclusion, the question of whether or not Medicare covers Benlysta is a complex one. While the drug has been approved by the FDA for the treatment of lupus, it is still considered a specialty drug and may not be covered under traditional Medicare plans. However, there are options available to patients who need assistance in paying for their medication.

One such option is Medicare Part D, which covers prescription drugs. Patients may also qualify for financial assistance through the Benlysta Gateway program or the Patient Access Network Foundation. It is important for patients to speak with their healthcare providers and insurance representatives to explore all available options for obtaining the medication they need. With the right resources and support, patients can access the care they need to manage their lupus symptoms and improve their overall quality of life.