CLL, Medicare & support meds

[misterbee]

Hello all. I am about to retire (Mar 1) AND about to begin treatment for CLL - meaning we lose company sponsored BCBS and sign up for Medicare part D. I've been on the Medicare website and have an idea what Ibrutinib will cost on Medicare. I'm especially concerned about the "extra's" for CLL: neutrophil meds, IVIG meds, and hemoglobin meds. If I need all this stuff, I'm really in trouble. Does anyone have experience with receiving infusions at the docs office vs using subcutaneous injectables? Is one covered under Medicare B while another is covered under Medicare D? What's the preferred medication, monthly dosage and cost for Hgb, Neutrophil and IVIG medsfor for CLL patients? I'd like to plan for "worst case" when I select a Part D plan. So far, it looks like BCBS has the best plans as they cover everything?

[lankisterguy Volunteer]

Hi Misterbee,

If you are on conventional Medicare Parts A & B and get a supplement plan (type F or G) to covers all your copays on Part B, then any infusions or other drugs given while in the hospital or outpatient clinic will have no copay.

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Part D covers drugs taken at home, and most of those insurance policiess do have copays.

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The Medicare Part D drug plans vary widely according to zip code and formulary (how much copay is involved at each increment), but fortunately you can change plans every year between mid October and the first week of December.

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I have changed plans every year usually from one Express Scripts Medco plan to a newer Express Scripts Medco plan- they seem to change names of their plans and add a lower cost one annually and raise the monthly cost of the older plans each year.

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The Medicare Website has a tool that takes away all the confusion and allows you to see the annual cost for different plans.

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medicare.gov/find-a-plan/qu...

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Once you get to the website - fill in all your personal details on the first page and then go to the page where you enter your existing prescriptions, then add Ibrutinib/Imbruvica and choose 90 capsules for 30 days.

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When they ask about mail order vs. local pharmacy - you should choose local- it seems counter intuitive since the specialty pharmacies that send Ibrutinib always use FedEx, but the website considers that a local pharmacy.

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After all that entry- you will get a list of pharmacy names and plan names. The lowest total annual cost will be listed first and then in increasing annual cost. Some pharmacies will be listed multiple times with their different plan names. In my case the Express Scripts Medco with the lowest monthly cost is not the best deal, since the copay is higher, making it about $300 more per year total annual cost.

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It's complex and the only way to figure it out is to use the online tool.

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Len

[misterbee in reply to lankisterguy]

Thanks Len!

[lankisterguy Volunteer]

You can get excellent, free, unbiased help from your State Health Insurance Assistance Programs. (SHIP) provides free help to Medicare beneficiaries with information, counseling, and enrollment assistance.

medicare.gov/Contacts

You may want to get training now, since you can apply for Medicare 3 months before your birthday/retirement and coverage will start on the first of the month- before the actual date of birthday or retirement.

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Medicare Part B is your health insurance coverage. It covers two types of services, including medically necessary services to treat illnesses or conditions, such as doctor’s office visits, lab work, x-rays, and outpatient surgeries, and preventive services to keep you healthy, like cancer screenings and flu shots. Part B also covers medically necessary durable medical equipment such as wheelchairs and walkers to treat a disease or condition. Costs for Part B services vary, but frequently, you will pay a deductible and then 20% of the Medicare-approved amount, as long as you use providers who accept Medicare assignment.

Len