Dr. Ronda Marie Chakolis-Hassan

depending on what segment you have, changes.

So like now for Medicare Part D members, they have this maximum of $2,000 out-of-pocket max for the calendar year.

Well, now that's kind of maybe upsetting some PBMs and different things because what's going to happen is it doesn't matter once people get to those $2,000, it's going to be covered.

However, what

people who have Medicare and have these expensive drugs aren't told is when that comes up at the beginning of the year is historically, you might've had a copay.

Now what's happening is they want more of that cost sharing on the front end.

So a drug that might've cost you $35 because of a copay, when you come to the pharmacy in 2026, it might be $700.

Exactly.

there's another tool in there that if you're going to get to that 2000, who would have ever thought that we would have come to a place in the world where you actually make payment plans for your medication.

And so, um, you actually can get a payment plan with your insurance company.

If you're on Medicare, um, if you know you're going to get to that $2,000 out of pocket max.

Yeah.

I think so often we talk about the burden of care for the patients, but I also like to tell people there's a burden of knowledge for providers.

So for example,

You come in, you have 15 minutes to diagnose somebody.

Their world has changed.

It's assumed that you know what's formulary.

You know what their preferred pharmacy is.

You know if their pharmacy is even open on the weekends.

And a lot of that, we have to kind of put back in the lap of those patients.