Question about Medicare Part D Choice

[Zork1]

I am being treated for prostate cancer (Gleason 9) diagnosed in summer 2017. Treatments have included radical prostatectomy (July 2017), adjuvant radiation, and 2 years of Lupron. (Final Lupron shot was Oct. 2019). So far PSA has been undetectable. I don't know what the PSA will be after the Lupron wears off, possibly in mid 2020.

Since I have to choose a Part D plan by Dec. 7th, my question concerns what prescription drugs I might be prescribed if my cancer should recur. Specifically I am asking about drugs that would be covered under Part D Medicare coverage. ( I am enrolled in original medicare, not an advantage plan, and I have prescription drug coverage under a Part D plan.)

[Hex40]

lupron is covered under plan B. But 2 I would recommend to check is Xtandi and Zytiga.

[Tall_Allen]

If no metastases have been detected by then (which will likely be the case), Medicare may cover Lupron and Casodex. Other medicines are in clinical trials only, which will be covered as part of that clinical trial.

[Magnus1964]

Casodex is not that expensive. For zytiga you can apply to Johnson and Johnson for financial assistance. Provenge can be covered by the Patient Access Network. For assistance with xtandi contact xtandi Solutions.

All of these depend on financial eligibility.

[leo2634]

Go to Fund Finder.com register and when grants are available you will be contacted. Most cover any medication we all take and can help with the costs injection like Lupron are covered by part B. Part D is your choice for 2020 I'd say at least 90 percent of them have a deductible now so weigh out you medication costs and you can chose. Go to Medicare.gov and all the plans are there. Leo

[6357axbz in reply to leo2634]

Thank-you Leo!

[vandy69]

I was diagnosed in 2012 and was already 65. Since then I have had Zytiga once, Xtandi three times, and Lynparza once. All were covered by my Humana Part D plan. Amount covered depends on where you are on deductibles.

Since all of these retail for about $12,000/month, you soon get to the catastrophic portion of your coverage where you pay 5% of retail price, or about $600/month.

My highest annual retail cost was about $312,000 for which my out of pocket was about $20,000. Hope this helps.

Best Wishes. Never Give In.

Mark, Atlanta

[6357axbz in reply to vandy69]

Helpful info! Thanks

[herb1]

Zork1: I deal with this problem each year. The Drug D plan that gives me the lowest premium+drug cost while on Casodex may not be the best one for Zytiga or Xtandi. I find the Medicare.gov site, although tedious, to be the fairest. For me, one plan "A" total is $400/yr with Casodex (and a bunch of blood pressure meds). Substituting Zytiga or Xtandi, the premium+drug cost jumps to $8500 to well over $10,000 and the same plan "A" is not a price leader! As Clint Eastwood said: "so do you feel lucky, punk?" Shifting: why are you planning to come off Lupron, it seems to be working?

[Zork1 in reply to herb1]

Two years of Lupron was recommended by my docs.

[Hidden]

I know that blue cross plan 65 which is a supplement plan has Zytiga in the formulary on their top tier part D. Costs me 57$ a month. I think I pay 5% after reaching the donut hole which is the first month. I pay 2300$ first month then 530$ Per month and Mylan’s generic is 330$. Not sure about Xandi

[GIBasterian]

Are you on original Medicare? If so, go on YouTube to find Medicare Part D and Medigap agents.

Compare a Medigap F or G plan, or F or G High Deductible. For the Part D drug plan, you need to know what meds you are likely to need, now and later, then make sure the Part D plan you choose have those drugs in their standard formulary.

This is all pretty damn complicated, and you really need to find a good insurance agent who will work with you and your specific medical issues and medications.