Medicare coverage for long-term drug treatments can vary based on a variety of factors. The same is true for Radicava. Though your doctor will only prescribe this drug for certain treatment plans, many people have questions about it.
What is Radicava?
Radicava is one of two major brands of Edaravone. In the past, doctors only prescribed this drug for patients who had suffered from one or more strokes. After clinical trials, the FDA approved it to treat early-stage Amyotrophic Lateral Sclerosis (ALS). This condition is also known as Lou Gehrig’s Disease.
This drug is part of many long-term treatment plans to reduce the adverse symptoms of ALS. It also provides short-term benefits for stroke patients. However, it is not a cure for ALS or post-stroke complications. It merely slows the decline of physical function.
How is Radicava Used for Treatment?
Doctors provide Radicava via cyclical, intravenous infusion therapy. The FDA recommends a dosage of 60 mg daily for 14 days, each taking up to one hour. A 14-day drug-free period follows the initial treatment.
In later treatment cycles, you will receive ten days of drug therapy, followed by 14-days without it. This cycle repeats based on your needs and the recommendations of your doctor.
The treatment works by relieving oxidative stress. This is the imbalance between harmful free radicals and the antioxidants that counteract them. Research indicates that oxidative stress can lead to the death of motor neurons in people with ALS.
Oxidative stress makes it difficult to carry out everyday physical movements. Symptoms worsen over time as more motor neurons die. Thankfully, it reduces the effects of oxidative stress, slowing the decline of motor function for stroke victims and ALS patients.
This drug is a standard treatment for stroke victims and ALS patients due to its efficacy and mild side effects. Many patients have no side effects at all. A small number of patients get bruising, headaches, and gait issues. However, your doctor may recommend other treatment options due to the high price of the drug.
How Much Does Radicava Cost?
Like many ALS treatments, Radicava is not cheap. Without insurance, it costs about $1,000 per shot. This means that one year’s treatment costs about $146,000. Due to the high price tag, most patients require prescription drug coverage and supplemental insurance to cover the costs.
Coverage with Medicare and Part D
The type of Medicare coverage you need will depend on your treatment plan. Your doctor will determine the best course of action for your condition.
Medicare Part B views Radicava treatment as “outpatient care.” Therefore, Medicare does cover some of the costs – about 80%. The treatment must be administered at a doctor’s office to be covered by Medicare.
In addition, some Part D drug plans cover the cost of the drug for home infusion treatments. However, Part D only covers the cost of the drug; it does not cover the cost of the equipment or services that come with it.
Agent Tip
Adding a Medigap plan to your Medicare plan offers you the best savings on Radicava, if you receive the treatment at a doctor’s office.
If you have Medicare, Part D, or a Medicare Advantage plan with prescription drug coverage, your insurance might cover some of the costs for at-home treatments. Part B will pay 80% of the cost for the IV infusion treatment at a doctor’s office. Due to the high price of the drug, you may want to consider a Medicare Supplement plan (Medigap) to cover the remaining 20%.
How Can You Get Radicava?
As an FDA-approved drug, Radicava requires a prescription from your doctor. However, your insurance will decide if you receive treatment at home or an outpatient center. In any case, getting Radicava requires an exam from your doctor to determine if it is right for you. Typically, Medicare requires evidence of an ALS diagnosis to approve coverage. Patients who have suffered a stroke can also get this drug for temporary help with their recovery.
How Can a Medicare Supplement Plan Help Pay for Radicava?
A Medigap plan helps pay for the costs that Medicare does not cover. The most common expenses paid by Medigap include deductibles, copayments, and coinsurance. Medigap also pays for many out-of-pocket costs and services.
In short, Medigap can help pay for your ALS or stroke treatment in several ways. First, it can pay for any copayments. Second, it can help pay your Part A deductible (hospital stays). Finally, Medigap can help you pay the remaining 20% in out-of-pocket costs.
Now let’s look at a few scenarios to see just how much you could save with a Medigap plan:
- No Insurance: ~$1,000 per dosage; $145,000 per year
- Private Insurance: ~$200 per dosage; ~$29,000 per year (varies by provider)
- Original Medicare: ~$200 per dosage; ~$29,000 per year
- Medicare + Part D: ~$200 per dosage; ~$29,000 per year
- Medicare Advantage: – ~$200 per dosage; ~$29,000 per year (varies by provider)
- Medicare + Medigap: $0 to $200 per dosage; $0 to $29,000 per year (varies by provider)
*All of these figures assume that you have met your insurance deductible.
As you can see, there’s little difference in price between most plans. However, Medicare + Medigap offers the best savings on treatment. Moreover, Medigap can help pay your out-of-pocket costs, making it easier to get coverage for your treatment as soon as possible. So, if you want Radicava covered by Medicare, a Medigap plan is the way to go.
Bluewave Insurance Is Here to Help
Does Medicare cover Radicava? Yes, but how much you pay will depend on your level of coverage. If you have Medicare + Medigap, you stand to save the most on your treatment. This is where a Medigap plan with Bluewave Insurance can help.
Radicava is a long-term treatment for ALS patients and a temporary recovery treatment for stroke victims. Regardless of your condition, the drug comes with a high price tag. Without an insurance plan covering most of the treatment, you could end up with a big medical bill. Thankfully, Bluewave Insurance offers a variety of Medicare Advantage and Medigap options to help you save on your treatment.
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If you have further questions about Medicare or want to learn about cost-sharing Medigap options, call us at 800-208-4974 today!
