What Is the Difference Between Medicare Part D and B? How Will Lonhala Magnair Be Covered?
Do you think Lonhala Magnair will be covered under Medicare Part D or Medicare Part B?
Daniel from Buffalo, NY
Lonhala Magnair is the brand name for glycopyrrolate – a nebulized bronchodilator. Until its approval by the Food and Drug Administration on December 5, 2017, ipratropium bromide (brand name Atrovent) was the only muscarinic antagonist available for use in a nebulizer. However, it is short-acting and lasts 4 to 6 hours. Therefore, it needs to be used at least three if not four times in 24 hours.
In contrast, Lonhala Nagnair is the first long-acting muscarinic antagonist (called a LAMA) available for use in a nebulizer. It lasts 12 hours and should be used twice a day. See my post on December 7, 2017, for more information about this medication including its unique e-Flow nebulizer.
Nebulized medications are generally covered by Medicare Part B. However, Sunovion Pharmaceuticals announced that Lonhala Magnair will be covered by Medicare Part D. It is expected that Lonhala Magnair will become available in the Spring 2018.
Many patients in my practice ask questions about Medicare coverage. Here is a brief summary of the different types of Medicare health insurance. I will try to make this complicated program as simple as possible. However, that is a challenge.
Brief History of Medicare The law providing Medicare health coverage for those over 65 years of age was signed by President Johnson on July 30, 1965, and took effect in January 1966. In 1972, Medicare coverage was expanded to include those less than 65 years of age who had long-term disability and end-stage renal disease..
This program is administered directly by the federal government and has four parts:
- Part A is hospital insurance. It covers most medically necessary care in the hospital, skilled nursing facility, home health, and hospice. It is free if you have worked and paid Social Security taxes for at least 40 calendar quarters (10 years). You will pay a monthly premium if you have worked and paid taxes for less time.
- Part B is medical insurance. It covers most medically necessary doctors’ services, preventive care, durable medical equipment like oxygen, hospital outpatient services, laboratory tests, x-rays, mental health care, and some home health and ambulance services. You pay a monthly premium for this coverage.
- Part C allows private health insurance companies to provide Medicare benefits. See below for more information.
- Part D is out-patient prescription drug insurance. It provides coverage for the medications that you take at home. However, if you have Original Medicare (Parts A and B), you must choose a separate plan for Part D plan coverage. You must sign up with a private insurance company for Part D coverage that works with your Medicare health benefits.
Medicare Advantage Plans
You can choose to get your Medicare coverage through a Medicare Advantage Plan instead of through Original Medicare. These are private health health insurance companies that are approved by Medicare. Many are known as health maintenance organizations (called HMOs) and preferred provider organizations (called PPOs).
Daniel – I hope this lengthy answer is helpful. I have tried to explain Medicare health coverage as many patients tell me that this subject is quite confusing.
Please note, the advice provided is not a substitute for asking your health care professional about your specific situation.
Donald A. Mahler, M.D.