NEW YORK LETTER
The diagnosis was not encouraging, but there was a drug to contain the disease: in the spring of 2020, the septuagenarian doctor Sally Pinkstaff started taking one tablet of Revlimid every day. This drug manufactured by the Bristol Myers Squibb laboratory is believed to slow the progression of myeloma, a cancer of the bone marrow. “I was still working at the time, recalls this Baltimore diabetes specialist. The first month, in June, I paid $ 50 [43 euros]. »
Except that in the summer of 2020, Mme Pinkstaff retired, lost his private insurance and switched, as is the norm, to the Medicare retiree public health plan. And there, it is the shock: she discovers the price of her medicine, about 17,000 dollars per month, and stops taking it in July, the time to see more clearly in her finances. The addition is painful, despite his Medicare insurance: “In August, I had to pay 3,075 dollars for twenty-one pills”, she confides. In the following months, the bill reached $ 936. In total, the retiree had to pay for her medications $ 6,657 in 2020.
This mishap was an opportunity for Sally Pinkstaff to explore the intricacies of drug billing for retirees. Its insurance works on the very complex but classic system of the United States: first step, the first 425 dollars of medication are payable by you; second stage, you have to pay a quarter of the price of your drugs, which explains the amazing bill for August: third stage, if your personal “out-of-charge” exceeds $ 6,350, a level very officially qualified as “Catastrophic” by Medicare, you no longer pay “only” 5% of the list price of your drug, which has brought the monthly payments down to $ 936.
In 2021, rebelote: a huge bill of 3,175 dollars in January, which is reduced from February to 936 dollars, the ceilings “Catastrophic” having been exceeded. Mme Pinkstaff sought to reduce his bill. She therefore made a whole series of requests to Brystol Myers Squidd to obtain free treatment. “If you pay more than 3% of your annual salary in medication, you may be eligible for free. They approved it from July ”, explains Mme Pinkstaff, who will still have paid $ 7,854 in 2021.
$ 110,000 per year for Revlimid
As always, the American system includes safety nets, legal with the famous level “Catastrophic” reached each year by 1.5 million Americans, or associations. You still have to know how to navigate there. “Most people wouldn’t be able to do all of the legwork I’ve taken. They would not be able to provide all the requested documents ”, says Sally Pinkstaff. Lost in the bureaucracy and unable to advance the necessary cash, some Americans are led to not seek treatment, as did Mr.me Pinkstaff for a month.
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