Below is what I just messaged my pulmonary doctor:
You prescribed a new inhaler Spiriva. I today won an appeal by phone with my drug plan provider to change the cost of Spiriva Respimat 2.5 MCG INH from the Medicare Tier 4 high cost (as a non-preferred brand) to the lower Tier 3 cost (preferred brand). (The other class' drug, Incruse Ellipta 62.5 MCG Inh, is in the lower cost Tier 3).
I was transferred and interviewed by 3 different provider departments for me to explain why Spiriva was the better drug for me, and they wanted to know the full history of all the inhalers I have used and how they were a problem for me. They said I'd hear within 72 hours if the Tier change was approved or not. Within an hour, I receive a call back and was approved to have the Tier 3 price for the full year. (Spiriva is better due to the different mist inhalation process, that along with internet patient comments, showed it may have fewer side effects of a hoarse voice / laryngitis).
Now I can find out if Spiriva helps me and without serious side effects.
Because my Medicare plan has a deductible of $615, I will have to pay the full retail drug price, which is a cost of $487 for each of the first 2 months. About $1000. Outrageous. Middle class people cannot afford medicine today. Thank goodness that traditional Medicare now has an annual cap of $2100 (2026). With 2 drugs, I'll probably reach the cap in mid-summer, then drugs are free for the rest of the year.
Part of me feels it is crazy to pay $1000 up front just to find out if the drug works for me. It may not, so I've wasted $1000. Then if I try a second drug, another possible $1000 wasted. Whatever.