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Spinraza & Medicare Coverage
Hello everyone , hope you’re enjoying the weekend!
I have been approved for Spinraza by my private insurance. However, it will run out in November, at which time I will be eligible for Medicare. Before beginning, I want to be sure that future treatment will be paid for by my health plan. Do any of you know if Medicare covers Spinraza? I have contacted their offices but have not been able to get a definitive answer. I also contacted Biogen, and their representative was not sure either. Any feedback would be greatly appreciated! -
5 Replies
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My Medicare covers it.
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This is great news!
I was told that Medicaid does cover it, but had not been able to get a definitive answer from Medicare.
I have had several setbacks and much hesitation about moving forward with Spinraza. Hopefully, I can now proceed with the treatment.-
As far as I know the thing about traditional Medicare is that they don’t do prior approvals for this type of thing. From what I understand the hospital has to do “Buy & Bill” which can be risky for them especially if they’re a smaller institution. Since it is being covered though more places are willing to do it.
Has coverage been your main hesitation? If there’s any other concerns please don’t be apprehensive in asking.
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Hope it all works out Patricia! And yes, like DeAnn said, please don’t hesitate to ask if you have any questions about the injection process or anything else. We’re happy to help.
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Medicare does cover it, I was told they cover anything approved by the FDA. But if all you have is Medicare, be aware they only cover 80% of the cost (it’s covered under part B, not D) and you’re supposed to be responsible for the remainder. My hospital actually bills like $560,000 per dose which is then “negotiated” down so they only pay $125,000. I have an advantage plan on top of Medicare which limits my yearly out of pocket, so I don’t run into issues, but make sure you know what you’re expected to pay before you go into it.
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