Lupron & Xgeva Are they Covered by Medicare Part B?

[kakyse1003]

Is Lupron depot injection covered by Medicare part B when administered by a doctor? Same question for Xgeva?

[Magnus1964]

Because both are given in a doctor's office in the form of a shot both are covered under Part B.

[kakyse1003 in reply to Magnus1964]

thank you. I am just trying to get some clarity on the issue. It is my understanding that a medicine that is medically necessary whether an injection or an IV infusion and is administered by a doctor in their office is covered by Medicare part B.

[Kittenlover50 in reply to kakyse1003]

You can do a google search, too, and there is a list of meds covered under part b.

[Break60 in reply to kakyse1003]

Check your Medicare plan to see if the drugs you take as injections are considered part B or D.

[dhccpa in reply to Magnus1964]

Interesting as I start Medicare June 1, although I plan to have a separate Rx policy and a supplementary med policy as well.

[EdBar in reply to dhccpa]

Just be careful of Medicare advantage plans, they can make changes to their plan whenever they like leaving you with gaps in coverage.

Ed

[kakyse1003 in reply to EdBar]

oh yes i know. that is why I chose Plan G as a Medigap Supplement

[CalBear74 in reply to kakyse1003]

Before investing in a Medigap product, consider investigating United health services Medicare advantage PPO and their drug coverages. I have been using them for years and have not bothered with the Medigap product. UHS also offers dental coverage, which is really a discount program, and hearing.

[dhccpa in reply to EdBar]

Thanks probably going with United Health AARP plan

[EdBar in reply to dhccpa]

I have the BC/BS Anthem drug plan and based on my meds it works well. I have Humana for my supplemental.

[Magnus1964 in reply to dhccpa]

I just checked my Medicare statements, my Xgeva shots which are given in the doctors office are covered under Part B. I am fairly certain that would apply to any medication given by injection in a doctors office.

[Break60]

Unfortunately you must buy it at the pharmacy and bring it to your doctor to get injections. So xgeva itself is covered under part D of original Medicare which means you have co pays while the inexpensive injection is covered under part B.

[Break60]

A few years ago Lupron was ordered and injected by the doctor so it was covered under partB. Then to save money, Medicare required you to buy Lupron from an authorized pharmacy so you had to pay the copay under part D similar to xgeva.

Since I no longer take either one I’m not sure how it works currently but google Medicare to find out.

[Magnus1964 in reply to Break60]

Wow, I am in Pennsylvania. What state do you live in? I have been receiving Xgeva shots for about 4 years and I never had to pick up the drug at a pharmacy. I know Medicare plans are different for each state.

[Break60 in reply to Magnus1964]

South Carolina. I lived in Villanova PA from 92-01. It’s strange that plans would be so different.

[dhccpa in reply to Break60]

That sucks but what else is new?

[rmarkley]

I get my monthly Firmagon shot and my every 12 weeks Xgeva shot at my doctors office. No pick-up, no copay. I do pickup my abiraterone at my specialty pharmacy with a $85 copay for a month's supply of 30 250 mg tablets. I live in Maine and have an Anthem Advantage PPO plan.

[Hidden in reply to rmarkley]

you mean a 30 day supply, 120 tablets. Right?

[rmarkley in reply to Hidden]

30 day supply for me is 30 250 mg tablets. I am successfully using the protocol of a single abi in the morning with food. I take the abi and the 5 mg prednisone immediately after breakfast. PSA is unmeasurable, and T is < 7.

[Hidden in reply to rmarkley]

I've heard of the reduced dosage with food, But wasn't an option for my. Sounds like you're doing okay. My Testosterone was less than 3 now it's less than 20. PSA was 629.0 now is 0.04. The bone mets is painful, and the pulmonary mets leaves me breathless with even minimal exertion.

[rmarkley in reply to Hidden]

An Axumin scan found a couple of small bone mets on my left hip. So I am metastatic. My oncologist and radiologist did not want to treat the bone mets. Oncologist said lets see what ADT does. He has seen it completely get rid of bone mets worse than mine.. I did have radiation 2 1/2 months in to the ADT. Abi was added after the first month. Why wasn't the reduced dosage of abi with food not an option? Several studies have shown equal effectiveness, and is much cheaper.

Are you going to try LU177, or RA 123 (Xofigo) for mets?

[Herman_PSA_OK in reply to rmarkley]

How long have you been on the Abi rmakley? Are you taking Xgeva? Thanks for the info.

[rmarkley in reply to Herman_PSA_OK]

I have been in abi since August, 2020., I started Firmagon in July 2020 and had abiraterone and prednisone added in August 2020. I suggested a Dexa scan, which showed mild osteoporosis. Xgeva was added to the mix, with an injection every 12 weeks. I take 2 calcium pills/day, as well as a bunch of vit D-like 4600 IU. I am on the 1-250mg abi pill with breakfast program, and it seems to work well - psa unmeasurable, and T<7.

Let me know if you have further questions.

[Herman_PSA_OK in reply to rmarkley]

Thanks for the reply rmarkley. I was diagnosed on June 2018 and I have been on ADT on and off with Lupron and Eligard 3-month shots. I even tried ADT using bio-identical transdermal estradiol for 18-months. I'm using currently as well as I re-started Eligard ADT again this past Dec. 21, 2020. I will be starting ABI this week.

MO wanted to add monthly Xgeva or Zometa to the mix and I declined after he refused to first give me a DEXA bone density scan saying it was not necessary. I'm also not going to add another drug or consider another until I take the ABI and see how it impacts me that first month which the MO I would need to be seen at least once or twice. It must be a real money maker for MO's. Your PSA and T are great numbers. Did you notice a drop when you started your ABI combo?

[rmarkley]

I am enclosing some medication tables, so you can get an idea of what I am doing.

Date Chemical Name Trade Name Dosage Procedure Duration

6/24/2020 Axumin Pet/CT Scan

6/26/2020 Bone Scan Whole Body

6/30/2020 Guardant360 blood draw

7/14/2020 degarelix Firmagon 2X120mg 2x3mL initial injection once

8/5/2020 Dexa Scan

8/11/2020 degarelix Firmagon 80 mg 4.0 mL 20mg/mL Injection every 28 days

8/11/2020 abiraterone acetate Zytiga 250 mg once daily with food continuously

8/11/2020 prednisone Prednisone 5 mg once daily with food continuously

8/29/2020 Covid-19 Test

9/1/2020 SpaceOAR insertion

9/8/2020 degarelix Firmagon 4.0 mL 20mg/mL Injection every 28 days

9/8/2020 denosumab Xgeva 120 mg Injection every 12 weeks

9/16/2020 Radiation

Date PSA

6/8/2020 32

8/12/2020 6.17 ADT started July 14, 2020

9/8/2020 0.58

9/30/2020 0.16

10/27/2020 <0.04 T<7

12/1/2020 <0.04

12/29/2020 <0.04

1/26/2021 <0.04

2/23/2021 <0.04

Note that radiation started about 2 months after start of ADT. That is SOC. With the SpaceOAR, I had no rectal or urinary problems with radiation. Radiation was 20 shots-5 days a week for 4 weeks. No big deal. The PET and bone scans found lots in gland and a bit in 2 small spots on left hip. MO feels ADT will clear up the bone mets. It has done that for him with previous patients with worse mets. I am using Firmagon because it is easier on my heart. I have lone atrial fib. Down side of Firmagon is shots every 4 weeks in the stomach fat, switching off between right and left side. Painful for 3-4 days Xgeva shot in left arm is no big deal. Hurts less than a flu shot or a covid shot.

Some PSA drop when I started abi, but it was heading down anyway. MO was happy with rate of decline. It is hard to tell if abi created any additional side effects, since they were started so close together. Minor hot flashes, and general work-out weakness due to low T. My biking speed dropped from 12-14 mph to about 10 mph on my trainer.