New Medicare recipient with metastasized prostate cancer needs to choose Part D prescription plan. Research so far shows cost of these meds is unaffordable even with the plans that are available.
Anybody know of any government or other assistance with the costs ?
Thanks in advance
Your Lupron shot is given in the urologists' (or medical oncologists') office and will be 100% covered by Medicare (provided you also have a supplemental plan for the 20% non-covered Medicare.) Generic versions of Abiterone don't appear to be horribly expensive, and I'd be surprised if you can't find a drug plan that covers at least part of the cost of a generic.
The drug plan calculator that the government has online is an excellent tool to determine your actual yearly total drug costs (cost of drugs plus cost of the plan..) There are plans that will be less expensive overall with lower drug coverages (you paying for more of the drug price.) You put in all your drugs - and the online tool does the work for you by checking all the plans available in your area and state.
Did enroll for Supplement Plan G. Did not realize that the Lupron is covered by Medicare, so thanks for that scoop. Did put both drugs into the Plan D cost calculator, and was shocked at the "cost to me" results, over $13,000/year. I will again omitting the Lupron based on the new info you've provided. Thank you so much !
$13,000 per year sound pretty bad... When I started Medicare wanted my copay to be $6000/mo. I worked another 1 1/2 yrs to get treatments on company medical ins. Good RX and VA have payed my meds since.
yes and, if one drug is Zytiga, I put it’s generic instead, abiraterone
Costco pharmacy has Abiraterone at less than $200 for 120 tablets
Good advice - thanks .
I get my Abiraterone using GoodRX, it’s $220/month vs $650 using insurance.
That's an excellent point - when you have the Medicare drug plan calculator open, you should also have GoodRX open so you can price paying for high-copay drugs yourself. Thats what I do for Cialis. My drug plan refused to cover it - it's about $20 per 30 tabs (average cost) using a GoodRX discount coupon.
Thanks, will try that.
Im paying $100 per month this year, vs $260 per month last year. Not often you see drug costs go down.
Thanks, will look into that, too .
Did I hear something about recently passed legislation limiting total annual drug costs to something more reasonable like $2000-$3000?? Also, how does "GoodRX" manage to provide such favorable options? Also, while with Kaiser, I once took a GoodRx coupon to a local paharmacy to purchase something that Kaiser did not cover...Pharmacy wouldn't accept GoodRx coupon because I was covered by Kaiser...even though not covered for that item!!!??? Pharmacist mentioned something about Kaiser and government program subsidy???
don’t use your insurance with GoodRx. Go as self pay for that drug
I'll try to remember that, but confusion is the norm for me.
I mentioned but didn't try to use my Kaiser insurance, as I knew it wouldn't be covered by Kaiser...not their standard of care. Are you saying I should have just told the pharmacist that I had no coverage at all? And no prescription either? Kaiser doesn't issue paper prescriptions...just electronic.....I can't remember if I had a prrescription....Kaiser Docs usually only prescribe what is covered....creates conflict when patient finds something was prescribed but not covered!! Do Docs normally avoid that situation. The drug was an alternative to the standard Kaiser over-counter prep for colonoscopy! Kaiser doesn't pay for over counter drugs...just prescription only..buy your own aspirins, not with Kaiser's $$ !!
you need a prescription. I am not sure how to solve that problem. Abiraterone should be covered, perhaps not Zytiga. Ask the dr for a paper prescription?
Just say no coverage at a pharmacy. It is true…you don’t want to use your coverage..
Yes to your first question- the Inflation Reduction bill, recently passed through Congress and signed by President Biden, will cap all drug costs at $2,000 per year for those on Medicare, starting in 2025.
Thanks for checking that Dan !
Portland Dale
Sure- seems like good news needing to be more-widely recognized. And just to clarify further- total out-of-pocket spending on ALL Rx drugs COMBINED under Medicare (part D or Advantage) will be capped starting in 2025 at $2,000. (see September AARP Bulletin).
Lupron is covered under your Part B and Supplement.
Abiraterone is available generically, so Med D plans, SingleCare, and GoodRX are options.
Thanks, will look into those options.
Lupron is fully covered under Part B. For generic abiraterone, try the AARP Walgreens drug plan. In Florida it offers AA for about $110/month.
Drug manufacturers often have assistance for low income seniors. If you are not low income then you will need to look at GoodRx and the other advice here.
Johnson & Johnson has a program for Zytiga that will pay 100% if you qualify.
I was on the J&J patient assistant program. Called 2 days ago to reapply for 2023 was informed program has ended. Small chance, maybe he meant I cannot reapply. My advise call and see what results you may get.... abiraterone was free as stated above. J&J 1-800 652 6227. Good luck
additionally, abiraterone is as effective (equivalent blood level and effects) for very many when taken as 250 mg daily dose with a breakfast including fat, such as a full fat cup of yogurt, as is the original 1000 mg dose on an empty stomach. With that strategy it goes 4 times as far.
Many here advise against Advantage plans. I am on Kaiser Senior Advantage Plan. Northern CA Kaiser low income Medical Assistance plan does not count assets. My only income is SSA and bank interest. That gives me a free ride, but not access to renowned Prostate Cancer specialists. After $600,000 for Xtandi for five years, and all the rest of the treatments, I am a Million Dollar Man. Cancer patients are cash cows. Moo, moo, moo.
Funny. Pizza, pizza, pizza. And Claussen Pickles.
Also try PAN (Patient Access Network) and Healthwell, just for two. I just checked and prostate cancer is closed (waitlist open) for PAN, but Healthwell is open.
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