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A Cardiologist Asks: How Much Is Too Much To Pay For A Promising Drug
The advertising campaign suggests Amarin has an agenda. By going directly to patients through advertising that does not mention the cost, the implication is that the cost is irrelevant.
There is a new advertising campaign for a high-priced medication that has caused me an ethical dilemma.
You may have seen a television ad about Vascepa, which in a recent study called REDUCE-IT was able to decrease the chance of having a heart attack or other cardiac event by 25%. This finding applied specifically to people who have high triglycerides , have lots of risk factors for heart disease, and who are already taking a statin medication to lower their cholesterol. When this study came out in 2018, it was huge news as this was the first time that a kind of fish oil has been proven to lower cardiac risk.
The company that makes Vascepa, called Amarin, has priced it at about $355 a month.
This is not an outlier. In cardiology, the cholesterol lowering drugs Repatha and Praluent came under pressure because they were so expensive. Most formularies have restricted their use, and the prices have started to come down.
The case of Vascepa seems different. There has been a move by Amarin to promote its product by distinguishing it from its competitors. Unfortunately, there are hundreds of brands of fish oil available both by prescription including generics and over the counter.
I received many emails similar to the one below, seemingly coordinated, almost to the word.
Mr Becker,
Information About The Launch Of Generic Afinitor
Effective Dec. 14, 2019, generic Afinitor is not covered on Humanas Medicare Advantage prescription drug and Part D plans brand Afinitor will continue to be covered with prior authorization and can be filled for the patient.
Prescribers with questions regarding this may call 800-555-CLIN , Monday through Friday, 8 a.m. to 8 p.m., Eastern time. Prescribers in Puerto Rico should call 866-488-5991.
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Information About The Launch Of Generic Mitigare
Effective Jan. 1, 2021, generic Mitigare is not covered or may require step therapy on Humanas Medicare Advantage prescription drug, Medicare Part D and commercial plans brand Mitigare will continue to be covered and can be filled for the patient.
Prescribers with questions regarding this may call 800-555-CLIN , Monday through Friday, 8 a.m. to 8 p.m., Eastern time. Prescribers in Puerto Rico should call 866-488-5991.
Aetnas Medicare Plan Options
First of all, its important to note that not every Medicare health plan whether from Aetna or a different Medicare-approved insurance company necessarily covers prescription drugs.
Most Aetna Medicare Advantage plans include prescription drug coverage. Theyre called Medicare Advantage Prescription Drug plans. But be aware that not every Medicare Advantage plan offers this benefit.
Fortunately, its not hard to find out if an Aetna Medicare Advantage Prescription Drug plan will help pay for your medications.
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Information About The Launch Of Generic Vascepa
Effective Nov. 7, 2020, generic Vascepa is not covered on Humanas Medicare Advantage prescription drug and Part D plans brand Vascepa will continue to be covered and can be filled for the patient.
Prescribers with questions regarding this may call 800-555-CLIN , Monday through Friday, 8 a.m. to 8 p.m., Eastern time. Prescribers in Puerto Rico should call 866-488-5991.
Is There A Generic Of Vascepa
Vascepa is a brand-name drug. It contains the ingredient icosapent ethyl, but there is no FDA-approved generic version of Vascepa currently on the market. SingleCare’s copay cards can be used at local pharmacies like CVS Pharmacy, Kroger, Walmart Pharmacy, and Walgreens for big savings on your next refill.
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Does Medicare Cover Vascepa
Millions of Medicare recipients rely on prescription medications to help improve or maintain their health. Vascepa is a medication prescribed by doctors to lower high triglyceride levels. If you are prescribed Vascepa, you may be concerned about the costs. Medciare Part D prescription drug coverage may be able to help.
What is Vascepa?
Vascepa, or icosapent ethyl, is an omega-3 fatty acid. You find these fatty acids naturally in fish oil. This medication is popular for use alongside a low-cholesterol and a low-fat diet. This medication works to lower high fats levels in your body. It does this by reducing the number of triglycerides your body produces.
To date, there isnt a generic version of this drug available. This means that you could pay more for it if your prescription drug plan doesnt cover it. Fortunately, many Medicare plans include Vascepa as a Tier Four drug. The Tier Four category refers to the non-preferred brand name and non-preferred generic drugs. This is the second most expensive category for prescription drugs and Medicare behind Tier Five.
Understanding Medicare Part D
Medicare Part D helps to cover the cost of outpatient prescription drugs you may need. Private insurance companies offer coverage as part of a stand-alone plan for people who have Original Medicare, or as a part of the set of benefits for recipients of a Medicare Advantage plan.
Costs for Vascepa
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What Do Silverscript Drug Plans Cover
SilverScript Part D plans have many coverage benefits, including:
- $0 copays for preferred generics
- access to a network of more than 65,000 pharmacies nationwide
- lower copays at more than 18,500 pharmacies for SilverScript SmartRx and 23,000-plus pharmacies for SilverScript Choice and SilverScript Plus
- cost savings for 90-day mail-order refills
- formularies that cover nearly all the drugs commonly prescribed to Medicare members
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Vascepa A Prescription Omega
Divya Gopisetty
Amarins Vascepa, an omega-3 fatty acid, shown to lower risk of heart attack, stroke, and heart-related death for adults with high risk for heart disease with elevated triglycerides
Editor’s note: this piece was updated on 11/13/18 to reflect the data presented at the 2018 AHA Scientific Sessions in Chicago. This piece was updated on 11/15/19 after the FDA Advisory Committee vote. This piece was updated on 1/6/20 with the FDA approval for label expansion.
Amarin, a Dublin, Ireland-based company, has announced positive results from its REDUCE-IT trial testing Vascepa, a prescription omega-3 fatty acid, in adults on statins with heart disease or diabetes and other risk factors for heart disease.
Data presented at the 2018 American Heart Association conference in Chicago showed that Vascepa resulted in an overall reduction in important heart-related events by 25%, including:
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20% reduction in death due to heart related causes
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31% reduction in heart attack
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28% reduction in stroke
The study followed 8,179 participants for nearly five years. Almost 58 percent of the trial participants had type 2 diabetes. On November 14, 2019, considering this data from REDUCE-IT, an FDA Advisory Committee voted 16-0 in favor of approving Vascepa for heart disease.
For most people in the US with private, Medicaid, or Medicare insurance, Vascepa costs about $3-6 per month with a co-pay card.
Information About The Launch Of Generic Symbicort Hfa Inhaler
Effective Jan. 11, 2020, generic Symbicort HFA inhaler is not covered or may require prior authorization for Medicare and commercial patients brand Symbicort HFA inhaler will continue to be covered and can be filled for the patient.
Prescribers with questions regarding this may call 800-555-CLIN , Monday through Friday, 8 a.m. to 8 p.m., Eastern time. Prescribers in Puerto Rico should call 866-488-5991.
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I Want To Know If My Current Insurance Covers A Medication
One way to find out your prescription coverage is to call the number on the back of your insurance card. This option may be the best source of information, as sometimes employers may have different coverage than what is published online. When calling, make sure you have the following information on hand:
- Insurance member ID: this can be found on your insurance card
- Name of the medication and the prescribed dosage
When prompted, provide your insurance member ID. Once the call representative has your account information, ask about the coverage benefits for the medication in question.
If youre already at the pharmacy, you can also ask the pharmacist whether the prescription youre picking up is covered by your insurance.
Additionally, most insurance companies also have portals and mobile apps that help you price a drug based on your current insurance plan coverage benefits. If you dont already have access to an online portal, you can make an account. Below are links to the registration pages for the main health insurers in the US:
- United Healthcare: Health4Me
As an example, here is what the process looks like on the Aetna mobile app quick and easy!
What Are The Possible Side Effects Of Vascepavascepa May Cause Serious Side Effects Including:
- Heart rhythm problems . Heart rhythm problems which can be serious and cause hospitalization have happened in people who take VASCEPA, especially in people who have heart disease or diabetes with a risk factor for heart disease, or who have had heart rhythm problems in the past. Tell your doctor if you get any symptoms of heart rhythm problems such as feeling as if your heart is beating fast and irregular, lightheadedness, dizziness, shortness of breath, chest discomfort or you faint.
- Possible allergic reactions if you are allergic to fish or shellfish. Stop taking VASCEPA and tell your doctor right away or get emergency medical help if you have any signs or symptoms of an allergic reaction.
- Bleeding. Serious bleeding can happen in people who take VASCEPA. Your risk of bleeding may increase if you are also taking a blood thinner medicine.
- Muscle and joint pain
- Swelling of the hands, legs, or feet
- Constipation
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Information About The Launch Of Generic Exjade
Effective April 1, 2019, generic Exjade is not covered for Humanas Medicare Advantage prescription drug plan and Part D plan members brand Exjade will continue to be covered with prior authorization and can be filled for the patient.
Prescribers with questions regarding this may call 800-555-CLIN , Monday through Friday, 8 a.m. to 8 p.m., Eastern time. Prescribers in Puerto Rico should call 866-488-5991.
Information About The Launch Of Authorized Generic Insulin Aspart And Insulin Aspart Mix
Effective Dec. 14, 2019, authorized generics for NovoLog and NovoLog Mix came to market. They are currently under evaluation for Humanas Medicare Advantage prescription drug plans, Medicare Part D plans and commercial plans brand NovoLog and NovoLog Mix will continue to be covered and can be filled for the patient.
Prescribers with questions regarding this may call 800-555-CLIN , Monday through Friday, 8 a.m. to 8 p.m., Eastern time. Prescribers in Puerto Rico should call 866-488-5991.
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What States Offer Silverscript Part D Plans
SilverScript offers three different Part D plans:
- SilverScript SmartRx
- SilverScript Choice
- SilverScript Plus
SilverScript Choice and SilverScript SmartRx plans are available to residents of all 50 states. SilverScript Plus is available to residents of every state except Alaska.
SilverScript offers prescription drug coverage through three different Medicare Part D plans. Heres an overview of each option well dive deeper into price details later in the article.
Medication Guides For Medicare Eligibles:
The Medication Guides are updated monthly. Links are included below to the Medicare approved Formularies and the most recent updates to the printed version of the Medication Guide for Medicare Eligibles.
Please have your patient refer to the pharmacy endorsement or rider issued with his or her contract, Evidence of Coverage, member handbook or certificate of coverage to determine whether a particular medication listed is covered. If your patient is unsure about particular coverage/benefits or has questions about the Medication Guide, please have the member call the Customer Service number on his or her ID card. The fact that a particular drug is listed in the guide does not necessarily mean that it is covered under each member’s contract, Evidence of Coverage or certificate of coverage.
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Will My Aetna Medicare Advantage Prescription Drug Plan Cover My Particular Medications
Each Aetna Medicare Advantage Prescription Drug plan has its own formulary. Thats a list of prescription drugs the plan covers, and its organized into tiers, which help determine price information. So check your plans formulary to see if it covers the prescription drugs that you take. Or, you can use eHealths plan finder tool and enter your prescriptions as described below.
Even if an Aetna Medicare Advantage Prescription Drug plan has your medications in its formulary, you may need to pay a deductible before the plans cost-sharing kicks in. You typically pay a coinsurance or copayment amount as well.
Indications And Limitations Of Use
VASCEPA® is indicated as an adjunct to maximally tolerated statin therapy to reduce the risk of myocardial infarction, stroke, coronary revascularization and unstable angina requiring hospitalization in adult patients with elevated triglyceride levels and established cardiovascular disease or diabetes mellitus and 2 or more additional risk factors for cardiovascular disease
VASCEPA is indicated as an adjunct to diet to reduce TG levels in adult patients with severe hypertriglyceridemia
The effect of VASCEPA on the risk for pancreatitis in patients with severe hypertriglyceridemia has not been determined.
VASCEPA was associated with an increased risk of bleeding in a double-blind, placebo-controlled trial. The incidence of bleeding was greater in patients receiving concomitant antithrombotic medications, such as aspirin, clopidogrel or warfarin
Common adverse reactions in the cardiovascular outcomes trial : musculoskeletal pain , peripheral edema , constipation , gout and atrial fibrillation
Common adverse reactions in the hypertriglyceridemia trials : arthralgia and oropharyngeal pain
Adverse Events, Product Complaints, or Special Situations may be reported by contacting AmarinConnect at 1-855-VASCEPA, emailing , or calling the FDA at 1-800-FDA-1088
Patients receiving VASCEPA and concomitant anticoagulants and/or anti-platelet agents should be monitored for bleeding
Please see full Prescribing Information for more information on VASCEPA.
*Data on file.
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Medicare Drug Plan Cost For Vascepa
Below is your cost or co-pay for Vascepa in Middlesex County Massachusetts. The chart includes the plans premium and deductible for every plan that offers additions coverage for Vascepa. You can also see if each plan requires Prior Authorization, Step Therapy or has Drug Quantity limit for Vascepa. Please check the formulary for different brand and generic drug names. Every Medicare Advantage and Medicare Part-D plan will vary on covereage, co-pays, cost and premiums. Knowing every plans details will help you get the best coverage and the cheapest prices for your medications in Middlesex County Massachusetts.
| Drug: |
|---|
Most plans have 4 levels of coverage. The exception is the $0 Deductible Plans.1.Pre-Deductable: Before you reach the plans deductible. Some plans offer select Pre-deductible drug Coverage.2.Initial Coverage Limit: After you reach the plans deductible but before the Initial Coverage limit.3.Coverage Gap: After you reach the plans ICL but before the Catastrophic of $6350 in 2020.4.Catastrophic: Anything over $6350 you will receive a significant increase in coverage.
Definitions:
What if a drug I need is not listed?
Information About The Launch Of Generic Tykerb
Effective Oct. 3, 2020, generic Tykerb is not covered on Humanas Medicare Advantage prescription drug and Part D plans brand Tykerb will continue to be covered and can be filled for the patient.
Prescribers with questions regarding this may call 800-555-CLIN , Monday through Friday, 8 a.m. to 8 p.m., Eastern time. Prescribers in Puerto Rico should call 866-488-5991.
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What Are The Side Effects Of Vascepa
Joint pain or muscle pain, constipation, swelling of the hands or legs, irregular heartbeat, and gout are common side effects that you may experience with Vascepa.
Since the active ingredient in Vascepa is found in fish oil, you should let your doctor know if you are allergic to fish oil or other kinds of shellfish. If you notice that you are experiencing an allergic reaction to Vascepa you should go to a nearby hospital. Signs of an allergic reaction include difficulty breathing or swelling of your face, lips, tongue, or throat.
Other serious side effects of Vascepa may occur. Consult your healthcare provider for professional medical advice should you experience side effects while taking Vascepa.
Vascepa Coupons And Rebates
Vascepa offers may be in the form of a printable coupon, rebate, savings card, trial offer, or free samples.Some offers may be printed right from a website, others require registration, completing a questionnaire,or obtaining a sample from the doctor’s office.
Vascepa Savings Card Program: Eligible patients pay as little as $9 with a savings of $150 per fill for additional information contact the program at 855-497-8462.
- Applies to:
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