Is Zytiga covered by Medicare Part B? - Advanced Prostate...

Advanced Prostate Cancer

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Is Zytiga covered by Medicare Part B?

Brbnbrn profile image
17 Replies

Hi All! I haven't been posting much but I've been reading your posts and praying for you all. I have a question I'm hoping someone can HELP me with. You all are so well informed.... my husband is loosing his retiree insurance in August due to turning 65 years. He has an option of Medicare or BCBS through my work. The big question that will determine which way to go is the prescription drug costs (donut hole vs. ACA out of pocket limit). The question I've asked our oncology department and have NOT received an answer is: "When he goes on Zytiga after his chemotherapy, will that be covered under Medicare Part B or will it be prescribed and I have to go to a pharmacy with a prescription?" If it is not covered by Part B, I'm hoping the $6,600 out of pocket expense limit will help make this more affordable! Even after exiting the "donut hole" it will still cost us over $500 a month! It's so hard loosing the pension insurance as it is WONDERFUL coverage!

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Brbnbrn
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17 Replies

Wish I had a better reply other than saying that it is covered by Medicare part D, copay unknown.

BCBS through your work is a good option, Their catastrophic clause allowed me to cap my treatment costs at $5,000. per year, including all drugs. I currently carry BCBS, Medicare A & B, and full VA care. I never see a bill even if I go outside the VA.

From what I studied, BSBS prescription coverage is basically on par with Medicare part D.

You can go to the Medicare site and "plug in" Zytiga. Different Part D providers will list co pays.

You can also call BCBS and they will tell you the co pay for Zytiga through the mail order drug plan. I used to get Neulasta delivered to my house using that method.

This might help..

healthpartners.com/ucm/grou...

Checked my BCBS coverage for Zytiga. They want $60.00 for 30 Zytiga 500 mg Tablets. That's from a retail (Kroger's) walk up pharmacy.Please note I have the Federal employee health benefits version of BCBS.

From the Zytiga web site, "The recommended dose for ZYTIGA® is 1,000 mg (two 500 mg tablets or four 250 mg tablets) administered orally once daily in combination with prednisone (5 mg administered orally twice a day)".

Looks like the BCBS co pay would be $120.00 a month

Hope this helps, please double check my numbers by going to the BCBS web site.

Good luck.

Brbnbrn profile image
Brbnbrn in reply to

Thank you! This gives me a new perspective. It's so hard to deal with this during the throws of the relatively new Stage IV dx. Life has changed so quickly!

in reply toBrbnbrn

You are very welcome, anything we can do to help, please don't hesitate to ask. Yes your life has changed quickly, my first year was a blur. It helped me dealing with my new partner cancer by slowing the moments down, gaining a "damn the torpedo's" attitude and going back to my normal routines. Your lives are forever changed, adjust.

Final note, Don't Google life expectancy charts, all they do is stress you and cause sleepiness nights. Check your husband from head to toe sometime. I guarantee you won't find an expiration date anywhere. One of our astute members Dan59 was diagnosed with stage 4 prostate cancer 12 years ago. Life is far from over, a new life has begun. Enjoy it.

Good luck.

Kittenlover50 profile image
Kittenlover50 in reply to

Ours was not covered by Medicare, but by BCBS speciality part. 30.00 co pay a month. Zytiga was over 9,000 monthly. He was on for 18 months.

Brbnbrn profile image
Brbnbrn

Wow... thank you Bill! That was so much more than I expected... 🤗🌷⚘

Mkeman profile image
Mkeman

My hospital has a cordinator who works with patients to find the best way to pay. The cost of my Zytiga is about $12000 a month. I had to pay $2800 the first month and now pay $560 a month. If President Trump would allow Medicare to negotiate directly with drug companies as he promised before the election, I 6hink the cost would come down for all of us.

Brbnbrn profile image
Brbnbrn in reply toMkeman

Yes, I agree... one good thing though, Johnson & Johnson just lost their patent on Zytiga and there may be a generic as soon as October 2018!

lincolnj8 profile image
lincolnj8 in reply toMkeman

There are foundations that will pay the $560 a month for you depending on your income. Your oncologist group should know about these foundations..

benninger profile image
benninger

Just heard from husbands insurance yesterday our copay will be 2644.60 per. mo. Thankfully we have some help for the next 3 mos. Nurse coordinator said to wait until first of year to apply directly with zyitga when funds are available for a full year. Husband on medicare but our supplement is thru a trust from his employment. Every supplement and insurance is different on what they pay.

Brbnbrn profile image
Brbnbrn in reply tobenninger

I am just overwhelmed at all the options. I want to do the right thing or best thing, to start. I know we'll have optuons to change during open enrollment, but I don't want to loose our life savings by making the wrong decision!

Litlerny profile image
Litlerny

Medicare is a conundrum to say the least. I would go to the medicare.gov website for more info. Also, AARP has a good online guide to Medicare in general and (specifically) Medicare Part D that you can Google, that should help answer some of your questions.

Medicare Part B has only limited coverage of prescriptions, and no donut hole. Medicare Part D is the principal Medicare prescription coverage program, and has the donut hole.

Good luck!

Brbnbrn profile image
Brbnbrn

I've always heard about the donut hole bit living it is quite different! Thank you for your help!

Magnus1964 profile image
Magnus1964

You would have to look at the Formulary of the Part D plans to determine how much they would pay for Zytiga. Also call BCBS to see what they would cover. I can tell you that with a $6600 per month drug. It is not going to much.

Your husband's Urologist should be able to get the expense paid for through the Patient Access Network. I have been on Zytiga for the last 2 years and they have coved all of the cost for the drug. I hope you qualify, you will have to send in your latest IRS tax filing.

Brbnbrn profile image
Brbnbrn

1st I've heard of "patient access network"! Brian "fired" his urologist when he took 3 months to biopsy his elevated PSA. It went from 540 at 1st to biopsy of over 1,300 and Gleason of 10 for all 12 biopsies. NOW, his DO has, as if last night's news, had his license withdrawn due to iver prescribing if opiods! What a world...

Brbnbrn profile image
Brbnbrn

Sorry for the typos... hope you got it!?

MomOfMaisy profile image
MomOfMaisy

My husband gets his 1,000 mg. of abiraterone (Zytiga) through Mark Cuban’s Cost Plus Drugs for around $119 a month. Much lower priced than what our Medicare Rx plan would pay. Or even programs like Good Rx, etc. It’s been a lifesaver.

Mormon1 profile image
Mormon1

use goodrx. $125. Monthly. Much cheaper. Keep the D plan to avoid penalties

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