tgif i guess Posted July 23, 2023 Share Posted July 23, 2023 please remove if threads like this are not allowed my question is about the cost of alimta. my oncologist said my private insurer will not cover the cost of the drug. it was covered for months but the reimbursement rate changed. as i understand it, private insurance cannot pay less than medicare but are allowed to pay more. there seems to be a 'bio similar' drug, pemfexy. looking at the coding for alimta, the average sales price: ASP Drug pricing - J9305 Jul 1, 2023 - Sep 30, 2023 10 MG 7.933 April 1, 2023 - June 30, 2023 10 MG 17.141 January 1, 2023 - March 31, 2023 10 MG 27.681 October 1, 2022 - December 31, 2022 10 MG 47.747 Jul 1, 2022 - Sep 30, 2022 10 MG 78.393 from july of 2022 to july of 2023 the reimbursement for medicare dropped. which means private insurers can drop theirs. pemfexy is currently at 64.476 after a delay in treatment, the office manager found a source for alimta but not sure how long they will offer it at that price evidently it is illegal for me to pay the difference in price - but i assume i can pay the full price anyone else having problems getting alimta? Tom Galli 1 Link to comment Share on other sites More sharing options...
Tom Galli Posted July 24, 2023 Share Posted July 24, 2023 TGIF, Oh my, I hope others are not having difficulty getting Alimta! Paying for it (and for all new medications) is always another matter. I believe your information about Medicare pricing is correct. Medicare is insurance. It is a very large program and is often a market maker price-wise but you are correct. There is no requirement for private insurance plans to adopt Medicare pricing. I'm glad your clinic found another affordable source. Stay the course. Tom tgif i guess 1 Link to comment Share on other sites More sharing options...
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