Just noticed recently that Lupron is available to purchase as a kit from pharmacies.... My understanding is that this is a Part B covered drug... Guys on Lupron here... are you purchasing it outside and bringing it to the MD's office or is it being taken care of AT the MD's office ( drug and injection) thus under part B........thanks..... I'd like to not go bankrupt due to this disease.
Lupron covered under Part B - Advanced Prostate...
Lupron covered under Part B
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Tommyj2
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Medicare pays for Lupron . Doctors' office should handle the drug and the administration.
thank you for your input.... Part D is also, technically, Medicare... but I am specifically asking if the MD's office provides the service of procuring the drug AND administering it and then billing it under Part B.... it sounds like this is what you are saying no??
The doctor should order the drug . The doctor's office must handle everything procuring the drug and injecting the drug to the patient. The doctor's office bills medicare for everything and the patient pays the copayment if any.
Yes...thats the way it " should " go and the way I assumed it DID go until I read a number of exceptions here in the forum.... that's why I put out the question. Fortunately it appears that the majority optinion and experience is that part B covers the injectibles....... UNfortunately it appears that the new stuff coming out is oral....NOT a good thing for those of us on part D.
Tommy..I like what you say "I don't want to go bankrupt..." You should not. Its a noble deed to leave some money to your wife and children...its bare minimum what we can do for them for their care ,love and suffering they along with us...its cool to be frugal..and enjoy simple pleasures.
I don't have any wife OR children..... I'd love to be noble but I am here REALLY referring to going actually bankrupt.... I simply do NOT have the money to afford these drugs.... will have to determine treatment by what I can afford rather than what the MD's think is best for me unless I can get assistance....
No wife or children?....Then make me your beneficiary....👀I
Good Luck, Good Health and Good Humor.
j-o-h-n Wednesday 07/31/2019 5:27 PM DST
Then you'd best hope for my passing VERY soon !! If I continue treatment for this disease there will be precious little left : ) Frankly...when I look down the road at all the potential complications and QOL issues passing sooner rather than later suits me just fine...
You'll be around for a very very long time..... and that suits me just fine.... In fact I may make you the beneficiary of my will after my wife and my son (and of course the ex-wife). Hang in there....and laugh.....
Good Luck, Good Health and Good Humor.
j-o-h-n Thursday 08/01/2019 11:35 AM DST
My Firmagon drug and shots were administered in the Dr’s office and paid for via Medicare Part B.
You aren't buying the firmagon yourself under part D and having it administered in the MD's office?..... I "heard" that's the way it is handled now with Firmagon and that worries me given it's expense.
Thats good news!! I'm getting the idea that when some of these drugs initially hit the market they , for a time, are covered under Part D and are later moved to part B.... Just an impression I get from the responses here.. Glad for you ( and ME) that Part B is covering it for you.
The whole thing about no cap on spending with part b is scary for us. You can pay 20% of everything over and over. Even worse, the 5% copay ( after the $5050 deductible). That’s like $500/mo for just the Xtandi. Sticking with the cobra for now
I don't have the cobra option.... If you are over 65 be careful about keeping cobra ( unless you are also paying for Part B) as there will be a late enrollment penalty when you do finally switch over.... If my MD wants me on something other than Lupron I'll have a problem....
For most treatments Medicare part B pays a fraction of the list price charged and it pays 80% of the Medicare approved amount. You need a private Medicare supplement plan to pay the remaining 20% unless you have Medicare Advantage which has its own limitations. Medicare Part D pays for prescriptions and must be purchased from a private plan. There are co pays which decline with usage but there’s also an out of pocket maximum .
Hey Break... my compliments to you on knowing your medicare benefits WAY better than many on this forum.... there is a lot of confusing information going back and forth here and being confused about ones benefits can be VERY costly... I became a medicare counselor in order to get trained in medicare for my OWN purposes as well as help others.... still there are aspects of it that if I don't use regularly I have to relearn each time I deal with someone..... they don't make it easy.... and medicare is quite a bit easier to understand than medicaid!!!
I pray everyday for the cost reduction of Zytiga and it’s friends so that many of us can live out our days in dignity
When I was on Lupron my urologist procured it and administered it under Medicare part B. He switched me to trelstar which I ordered from a regional pharmacy which delivered it to my urologist and he injected it. It was covered under medicare Part C . So I had a declining copay. Go figure!
He said the switch to trelstar was required by Medicare to save Medicare money!
Now I use only estradiol patches which my urologist prescribes under Part D and I apply to my skin myself. This is at the end of the day the cheapest option ( although I have a declining copay )and for me the most effective and with least side effects.
This is the situation I wan't to avoid.... I switched from a part C TO a medicare supplement ( at over 200 bucks a month) so that I would have the expensive MD administered drugs covered under Part B.... If they are not going to be covered under B then I am wasting my time and money having a supplement... Have to see how it goes.... can't afford the other drugs without manufacturer assistance... Glad the Estrogen is working for you....there appears to be an ongoing controversy about these on this forum... is your PSA and testosterone well under control??
BTW.... sounds like the Trelstar was covered under the part B portion of your Medicare Advantage Plan and you were responsible for the 20% copay ( Advantage Plans roll parts A and B and D into one package and call it part C) now you are buying the Estrogen patches with assistance from Part D..... I'm asking my question to be SURE that folks are getting their Lupron under part B and NOT D. Seems that they are...
Trelstar was not covered under Part B at the time ( around 2017-18) which is why I had the copay which declines gradually. I believe it had fewer side effects than Lupron. The reason I have Original Medicare and supplement plan F with Mutual of Omaha is not for medications but for Plan B treatments like surgery, radiation, etc which are many times more costly than medications for someone with stage IV and free. Plus I want to be able to go anywhere in the US for treatment which I have done . I want no part of asking whom and where I can go for tx. Part D is good because of the out of pocket maximum.
Lupron is covered under Part B but imho Lupron is terrible.
I’ve opined frequently on estradiol patches. Imho they’re awesome. See my profile for history.
Bob
I'm getting the impression that some of these drugs when they hit the market go onto part D initially and are later moved to part B.... another fellow here mentioned that he had to buy his own firmagon( hows THAT for a true name : ) somebody had a sense of humor)... Still... looks like the injectibles will be part B covered for now....whew!!!
I got my Lupron administered in my uro's office. My GP wasn't able to do it because it's somewhat complicated. Medicare and plan F paid for the whole thing.
Thank you for the response..... the way it is SUPPOSED to work is that Medicare picks up 80% and we are responsible for the remainder.... If one has a Medigap THAT will pick up the remainder seamlessly... MY worry was that seeing it available as a kit that it had shifted to Part D which would mean my paying WAY more for it. As long as others here are having it paid for by Medicare Part B...great...
Tommy , to clarify , I have Medicare A&B , and a plan F supplement. I had my injections in my Urologist’s offices and all was covered. I also have a part D drug plan that never came into play at all. judg69
Very clear and unambiguous response!! Thank you!!! This is exactly what I was asking.... As long as Part D never came into play I am OK.
Just for my own interest... where are you located and how much do you pay for your supplement? ( of course if you don't care to answer that it fine) I ask because in NY these plans appear to be FAR more expensive than elsewhere and I cannot figure out why... I pay 240.00+ for my Plan G ( plan F is more) in NY
I live upstate in Onondaga County. Thru AARP Plan F is $224 and Plan G is 196. I believe the AARP plans are the cheapest.
You are right. I do some volunteer medicare counseling in Orange County NY and the AARP plans are consistently the lowest priced..... Hope it remains that way!!!
I used to travel down and stay in the Newburgh area when I had service calls at the Plattekill Service Area on the Thruway and Shawangunk Correctional Facility. I probably still be doing so today if my PSA hadn't increased 3 years ago when I left work on disability. I used to enjoy the ride down route 17/84.
I’m in SC and after eight years my plan G is about $230. It started out at like $106 if I recall. All supplement plans are exactly the same in terms of coverage from carrier to carrier. I hate AARP for implying they are the only approved plan. Their rates may be somewhat cheaper due to higher volume .
My understanding is they are phasing our part F next year
Wouldn’t surprise me. All it covers that plan G does not is the Medicare deductible.
NEW purchasers of Medigap policies will not be able to get a plan F... People who are over 65 and currently have a medigap policy can still get it and if you already have one you can keep it( they NEVER make it simple : ) Over time it will not make sense to keep a plan F as diminishing enrollments will see the price increase dramatically and it will not make fiscal sense to keep F over a plan G ( where, as Break60 points out) the only difference is not covering the plan b deductible
Tommy: I get my care from a community oncology practice (non hospital based) in Syracuse. So far I am only taking Casodex which is an oral drug covered by Part D.
A couple of weeks ago the practice sent out a notice that they would not administer any drugs (via injection or infusion) that they did not procure themselves. I believe some insurance plans were trying to get them to use drugs procured by the insurance company. So I think you're safe getting Lupron thru Part B.
That is actually good news IF a lot of practices stand up and refuse.... There are liability issues involved not unlike a mechanic who installs customer purchased parts ( only FAR more serious)... Pisses me off that medicare is moving in the direction of having people buy their own cancer drugs.....they KNOW that most of america can't even BEGIN to afford such medications.... I literally will HAVE to die if I have to pay for currently Part B covered drugs.
BTW... is Casodex keeping things under control for you?? That is about the most inexpensive way to go with this disease and if it works for you over the long haul that is terrific!!!
I've been on Casodex monotherapy for about 100 days. My PSA when I started was above 900. Three weeks ago it was below 60. My CT scan has improved as well. Only side effects have been nipple tenderness. I don't know if gynecomastia has started yet. I haven't taken any measurements. I have had PCa for 17 years and understand that control can be as good as cure. The Casodex is the only treatment I've had. I don't understand why physicians push the "standard of care" which includes Lupron.
Are you saying that the only Treatment you have had for the past 17yrs for PCA is the last 100 days of Casodex monotherapy.... I read your profile and that is what it appears to suggest..... If so... what made you decide to pursue ADT at this time?? You could avoid additional questions when ASKING a question by filling in your profile such that this point is clarified...EVERYone will want to know how you have managed so long without Tx and if you have distant Metastases.... Am I missing something??
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