OD Referral
In the past, patients with Medicare Only and Medicare Advantage plans were eligible to enroll in the Good Days program, a national non-profit charitable organization, which assisted with offsetting the cost of patient responsibility co-insurance for injections based on financial need. Unfortunately, Good Days has not received adequate funding to continue to aid all eligible patients.
As a result, unless there is additional funding received, moving forward patients will be responsible for their coi-nsurance deductible amount at the time of their visit. As participating providers in the Medicare program, Retina Specialty Institute is required by federal law to collect unmet deductible, and co-insurance amounts for Medicare and Medicare Advantage plan beneficiaries if you do not have a supplement plan.
For many patients currently receiving a branded drug for their treatments this could reflect an increase in patient responsibility. With retinal diseases, branded drugs have been shown to be more effective in some patients.
Retina Specialty Institute recognizes the importance of continued treatment for their patients and may be able to offer treatment with Avastin at a lower cost for those who respond to it.
One practical alternative for Medicare patients, if not already obtained, is to acquire secondary or supplemental insurance.
For Medicare Advantage patients who are with BCBS, UHC, Aetna, Cigna Advantage Plus for example, you can try to switch back to traditional Medicare and if able, then a supplement like AARP Medicare Supplement Plan (Plan G).
You will need to call Medicare at 800-633-4227 to see if you qualify and know your options.
Lastly, you only have until March 31, 2025, to make the switch back to standard Medicare.
Branded Drug Patient Responsibility
- Byooviz – $557.93
- Cimerli 5 – $168.74
- Cimerli 3 – $101.25
- Eylea 2 mg – $336.45
- Eylea 8 mg – $537.13
- Izervay – $434.82
- Lucentis 0.3mg – $87.97
- Lucentis 0.5 mg – $137.14
- Ozurdez – $287.85
- Pavblu – $342.99
- Syfovre – $442.08
- Vabysmo – $411.03
- Yuliq – $1,455.24
