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Hello,
I'm hoping someone can provide any further info here. My father neglected to sign up for Medicare Prescription during open enrollment last year. And, earlier this year, he was diagnosed with Pulmonary Fibrosis. There is medication to help with his severe case of Pulmonary Fibrosis. But, without Medicare Prescription, the medication costs over $30,000. Does he really have to wait until Open Enrollment at the end of the year to sign up for Medicare Prescription (Part D) so that he can get his medication? Can anything be done to where he could sign up now for Medicare Prescription and pay the penalty so that he can get his medication? Any advice or guidance here would be greatly appreciated. Thank you!

I just want to say "thank you!" to everyone who has replied to my post. I greatly appreciate the suggestions, ideas, etc.
My stepmom and sister have been running into dead-ends over the past month in dealing with this situation. And, all of the tips and suggestions here are very much appreciated.
I am following up on a number of these suggestions. And, I will supply an update as soon as I have more information.
But, again, thanks everyone! What a great forum!
Helpful Answer (3)
Reply to frodriguez67
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In the future when your Father purchases a Plan D Rx plan, make sure to call the insurer first to make sure the meds he needs is on their formulary so that he can know it's even covered. And if they cover the generic or branded version. The deductibles can be very high.
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Reply to Geaton777
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Google. Medicare.gov. Special Enrollment Periods part D.
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Reply to Beethoven13
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There are some exceptions scenarios where you can sign up for Part D coverage during the rest of the year. Like if person was in rehab facility and about 4 others. Google. There may be small penalty but it’s worth it for the coverage of high cost drugs. My elderly mother never signed up for part D. She has traditional Medicare. I found her a plan with Blue Cross on line. About $120. Per month. There is a deductible to meet. Google it. I don’t think you have to wait to open enrollment if you can meet one of the exceptions. Good luck
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Reply to Beethoven13
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I want to encourage anyone looking into changing from standard Medicare to a Medicare advantage plan to thoroughly research the costs.

My dad's "Advantage" plan had an annual deductible that was more then twice the annual premiums for the supplemental plan and prescription plan. He was not getting proper care because of this, when he went to Medicare with supplemental and script plans he KNEW the monthly cost and was therefore able to get proper medical care by taking the unknown cost away.

I, personally, would discourage anyone that is sick and needing care from switching from regular Medicare. Just my experience and opinion.
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Reply to Isthisrealyreal
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Northwest Pharmacy is a reputable, licensed Canadian pharmacy.

They carry both OFEV (Nintedanib Esylate) brand name and a generic version that is much cheaper
https://www.northwestpharmacy.com/product/ofev
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Reply to Moondancer
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Switch him to a Medicare Advantage plan, they often cover Rx.
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Reply to Lovemom1941
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frodriguez67 Jul 10, 2024
Thank you for the reply. I'll look into this as a possibility.
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Is it Esbriet that he was prescribed?
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Reply to igloo572
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frodriguez67 Jul 10, 2024
Actually, it is Ofev that was prescribed.
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See 1 more reply
Thank you everyone. I really appreciate all of the advice, tips, etc.

I did reach out to an insurance broker for Medicare yesterday. But, he informed me that enrollment is locked until October 15th. And, that other than paying cash for the medication, there's nothing that he could do.

But, I'll definitely explore calling the Mark Cuban Pharmacy site and the SHIP State Health Insurance Assistance Program, along with reaching out to the drug manufacturer for compassionate use.

Again, thank you everyone for the advice and tips. It's very much appreciated.
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Reply to frodriguez67
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97yroldmom Jul 10, 2024
Appreciate the feedback.
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I’m no expert—so I imagine that an (independent) broker/agent (probably for traditional Medicare not Advantage as MACinCT says) makes sense for this complex situation. However, if you need details about the penalty , how much it is, and process AARP has a good site, link below.

(Honestly, they make it sound like someone could just push through on Medicare Plan Finder and do this without the agent/broker. That might be worth *partially* exploring just to learn, even if you don’t finalize there, just to make sure you know the process.)

https://www.aarp.org/health/medicare-qa-tool/part-d-sign-up-penalty-after-first-eligible/
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Reply to Rumbletown
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Also look up Mark Cuban Pharmacy. If they have your fathers prescription, it might be less.

https://www.markcubancostplusdrugcompany.com/
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Reply to 97yroldmom
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This is a medication that is meant to slow progression but not to improve symptom relief. He most likely had PF for many years before diagnosis. You only need to get through 6 months. Another option is to contact the drug manufacturer and ask for compassionate use until he is insured.
You should contact the insurance broker to help you find a plan that offers the lowest co pays for this drug. BTW, because he missed the opportunity to enroll for part D. He will pay a slightly higher premium as a penalty. The broker may also inform you that because of this lapse, his plan might have to be underwritten. This is an important reason that you now need a broker. There should be no cost for this appointment. Please search for an independent broker and not one who specializes in a specific insurance to an advantage plan. He may do best with traditional Medicare. Advantage plans are for healthier people without a serious chronic illness. Good luck
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Reply to MACinCT
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igloo572 Jul 13, 2024
“You only need to get through six months”

Exactly!
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Call the SHIP number for his state. You can find the number on Medicare.gov or Area Agency on Aging.

SHIP State Health Insurance Assistance Program


https://acl.gov/programs/connecting-people-services/state-health-insurance-assistance-program-ship
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Reply to 97yroldmom
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Call your local pharmacist and see if there is help.
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Reply to JoAnn29
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Call an insurance broker for Medicare, they can help you with this.
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Reply to Isthisrealyreal
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