Medicare M3P

[kreg001]

For USA Medicare folk I just set up my monthly Nubeqa purchase using WellCare zero dollar per month plan D and the Medicare Prescription Payment Plan (M3P). WellCare staff handled my M3P application very efficiently over the phone. I contacted my Specialty Pharmacy with a temporary M3P number and instead of taking $2,000 from savings or using a credit card I’ll be paying $166.67 per month interest free for 12 months. Nubeqa arrives tomorrow. As soon as my local pharmacy is aware of my M3P I’ll upgrade my Vesicare prescription to Myrbetriq at no cost. If I’d been smarter in November I should have looked for a low cost Plan D with Gemtesa in their formulary. Oh well. I’m very happy with what we have. FYI.

[Bspouse]

good to know we can call to get a payment plan and pay monthly instead of $2000 in January when bills are already high from the holidays. Thanks

[Mjex]

I have Wellcare as well. When I tried to get it instead of Erleada, Wellcare refused because i wasn't on Docataxel (I am still hormone sensitive). Was your situation comparable?

[kreg001 in reply to Mjex]

I’m castration resistant after three years of bicalutamide. Hope the Nubeqa works!

[Mjex in reply to kreg001]

Since it is not approved for hormone sensitive patients who are not taking docetaxel, I guess I hope I never have to find out. I am on Lupron and Erleada and wanted to try Nubeqa because I read the studies that said it had less side effects and was more effective.

[kreg001]

I’m hoping it will knock down my PSA for many years. I also read about the side effects and my MO agreed.

[85236442968]

kreg001 and all

Great work on understanding how the different part D plans work. One must always check the drug listings.

While on this thought, please keep in mind there are a number of foundations and Not-For-Profit organizations out there that will completely cover your co-pay.

Your Cancer Center Pharmacy can most likely hook you up with one of them.

[kreg001 in reply to 85236442968]

Yes. Good point. I was delighted WellCare had all the ARI’s and was no cost. But, I should have looked for a low cost Plan D with the ARI’s and Gemtessa. Next November.

[dhccpa]

Are you metastatic? I am supposed to be, but I see Bayer has applied for approval in metastatic cases. Still waiting.

[kreg001]

Any PSMA PET activity beyond the prostate bed is undetectable. Too small to be imaged. MRI doesn’t show cancer in organs or bones near my residual prostate. Some circulating tumor DNA in my blood serum but all variants are of uncertain clinical significance. No germ line DNA associated with PCA (PROMISE test). PSA now >6. Last year 0.1. T150. 6 months of Lupron hasn’t altered PSA doubling rate but squashed my T.

The tumor board concluded I’m likely non metastatic castration resistant (nmCRPCA) and no focal (local eg surgical, radiation, cryo, ultrasound, …) methods left to try.

Approval for darolutamide came in a few days. Another 4-5 days dealing with Specialty Pharmacy and getting the M3P approval, being repeatedly briefed, and receiving the pills.

To be fair, my Uro referred me in September after results from June Lupron showed unaffected PSA rise. So a few months went by meeting with mostly Cleveland Clinic surgeons, RO’s, MO’s, getting the PSMA PET, MRI, ctDNA, and other blood work before the MO presented my case to the tumor board 12-23. He phoned me with the boards recommendation 12-30 and said he’d order the darolutamide 1-2-25. It arrived 1-8-25.

Hope it’s effective with Lupron. Don’t want to go on chemo or immuno therapy yet.