My biggest concern is actually getting someone to cover the drug. Once covered, the cost will probably be manageable. My thought is to see if I can get a plan to agree to cover the drug before I sign up, but that seems ridiculous from their point of view. Why would they want to encourage me to select their plan when they’ll undoubtedly lose money on me due to this one drug. Ugh.
Three week old thread, but I just came upon it. If you're in a hurry, skip to the last paragraph.
Yours is another case of "you've got to buy it and try it before you find out what you bought" in the medical industry.
When it comes to picking a Part-D company, at least they show you the formulary beforehand. But if it's not in the formulary, or, as in the case in this thread [
Medicare Part-D ... Any Off-Label Experiences? ] it's in the formulary, but off-label, you can't know for certain what they'll do when the actual claim is made.
The case of off-label and the case of not being in the formulary might seem different, but similar in that there's a risk that the patient would be on the hook for the multi-thousand per month drug at the whim of the company's procedures.
Something I noticed is that if you have an expensive drug, the cost to the patient is exactly the same across all Part-D providers because of the way the limits work. This means that you choose (well, I choose) a Part-D provider based on customer service and monthly premium. I was going to sign-up for the "$0/month" one, but figured there HAD to be a catch, so I signed-up for the $5/mo one. But all in all of the research I did, I never found out if one provider had a better record on the escalation process for off-label than any other. Since then, I've become much less likely to even need the expensive drug (yippee!)
One thing you could try is find the discussion group for people that are going to be prescribed this drug, and find out "though the grape vine" if any of those people are using a Part-D provider that is working. Some people aren't comfortable with it, but often there's a FaceBook group that may be joined for people facing the same medical situation.