It depends on what plan you are on. Formularies for Medicare Part D plans vary quite widely. There are different processes to access more expensive medications like Besremi or Jakafi. It is worth noting the HU and Besremi are both recognized as first-line treatments for PV. Pegasys is recognized as preffered for ET/PV as well. HU and Pegasys are both off-label for ET/PV but in common use. Besremi has an FDA approved indication for PV only. Jakafi can be used but many formularies require failing on HU first.

The insurance companies that manage Medicare Part D plans prefer HU over the other options due to cost. HU = $25/month (60 caps). PEG = $4,200/month (4 doses). BES = $16,800/month (2 doses). It is very easy for a prescriber to get HU approved. PEG can be a bit more difficult. BES can be a challenge even though it is recognized as a first-line choice for PV. The extra time that a doctor spends getting a medication authorized is not compensated. This may influence the prescribing practices for some providers.

The bottom line is that all insurance formularies influence prescribing practices. This is done to contain costs and ensure profits. That is how the system works. We must be our own best advocates to access the treatment of our choice.

Thanks Tina.

Steve, I truly appreciate that you took the time to share information on this. I am becoming much more informed by using this web site. I hope you have a fabulous day. Jane