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Does Medicare Cover Ilumya?

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By Daniel Petkevich
Dec 7, 2022

It's covered on Part B if you get a doctor's approval

For those with plaque psoriasis, it can take many different medications or treatments to find relief from the discomfort. Once you find something that works for you, it can be stressful to ensure that you will receive proper coverage from your insurance provider. Luckily for those on Medicare, Part B covers Ilumya if it's considered medically necessary.

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What is Ilumya?

Ilumya (or tildrakizumab-asmn) is a prescription medicine used to treat adults 18 years and older with moderate to severe plaque psoriasis. It helps reduce the symptoms of plaque psoriasis by targeting certain proteins in the body that cause inflammation.
Ilumya is given via injection every three months and needs to be given by a healthcare provider. That is why it's covered by Part B rather than prescription drug coverage.

How does Medicare Part B cover Ilumya?

Medicare Part B covers Ilumya if your doctor determines it is necessary to treat your condition. Typically if other forms of treatment for your psoriasis aren't working or your psoriasis has worsened in severity, your doctor might recommend it. Medicare will help pay for the drug, but you may be responsible for some out-of-pocket costs. If you have

Medicare Supplement Plan G

, your out-of-pocket costs are limited to the Part B deductible. Be sure to check with your insurance provider or contact your local Medicare office to learn more about coverage and any associated costs

What are the side effects of Ilumya?

The most common side effects of Ilumya include upper respiratory tract infection, injection site reactions, nausea, and headache. Serious side effects may include allergic reactions and infections. Be sure to talk to your doctor about all the potential side effects before starting treatment with Ilumya.

How to get coverage for Ilumya under Medicare Part B?

If your doctor prescribes Ilumya to treat your condition, you will need to get a prescription from them. Medicare may cover some or all of the costs associated with Ilumya treatment, depending on your plan. Be sure to check with your Medicare plan provider for exact coverage details.
It’s important to remember that Medicare coverage is subject to change, so it’s best to check with your local Medicare office or your insurance provider for the most up-to-date information on coverage and out-of-pocket costs associated with Ilumya treatment.

Is there a generic alternative to Ilumya?

Currently, there is no generic or biosimilar version of Ilumya available. Patients with access to Medicare Part B may be able to get coverage for the branded drug. Talk to your doctor and insurance provider to learn more about coverage options and potential savings.

How to find a doctor who prescribes Ilumya

If you think Ilumya is the right treatment option for your condition, speak to a doctor about getting a prescription. Your primary care doctor may be able to prescribe Ilumya or refer you to a specialist who can. You can also search online for dermatologists or other specialists in your area who are experienced in treating plaque psoriasis.

Questions to ask your doctor about Ilumya

Before starting treatment with Ilumya, be sure to ask your doctor the following questions:
  • What are the potential side effects of taking Ilumya?
  • How often will I need to take Ilumya injections?
  • Are there any lifestyle changes or other treatments that can help manage my symptoms?
  • What other options are available if Ilumya doesn't work?
  • Does Medicare cover the cost of Ilumya?
  • Are there any discounts or coupons available to help lower my out-of-pocket costs?
By asking these questions, you can be sure you have all the information you need to help make an informed decision with your healthcare specialist.

Takeaway

In summary, Medicare Part B may cover Ilumya if your doctor determines it is medically necessary. Speak with your doctor to see if Ilumya is right for you. This content is for informational purposes only. If you have questions about your Medicare plan, call an expert at Fair Square Medicare today.

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Join the Fair Square Medicare Newsletter to stay informed on cost savings, changes to Medicare, and other valuable healthcare information.

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