Forbes February 14, 2025
Peter Ubel

Your father’s rheumatoid arthritis medicine was working well, fighting off that otherwise debilitating illness. Then he found out that Medicare would no longer pay for the drug.

Your aunt’s multiple sclerosis was flaring and her neurologist recommended a promising new treatment. But she learned that she would have to try, and “fail,” on two other drugs before Medicare would cover the new one.

Many people pay for Medicare coverage and are befuddled to discover that they still face significant restrictions on what medications they can take. Let’s see if I can defuddle the situation.

Quick Background Information

When Medicare was established in 1965, it did not pay for medications other than covering drugs patients received during hospital stays. That’s because...

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