Multiple cancer drugs on medicare part d

Hi;

just a question. Is anybody getting more than one drug for cll at the same time on medicare part d. say like imbruvica and ventolax. if you are did you have to get prior approval or did they just let you fill the second one.

thanks

[johnl]

I'm getting both of these drugs, but it's in a clinical trial. I don't think part d plans will pay for both at the same time until they are FDA approved as a combination therapy. part d pays for my ibrutinib and venetoclax is provided by the drug company.

john

[cllady01 Former Volunteer]

Since your diagnosis is P-LL , I would think your Drs. are working under a different diagnosis/need for your treatment than a CLL diagnosis.

The importance of the use of meds and their coverage should be an urgent and persistent task for the hospital/clinical office (and the connected pharmacy) to be attending to—but with your knowledge of that happening--you might ask about the situation there and get ahead of the game if you have not started on Venetoclax.

[Hidden in reply to cllady01]

actually they are working the high risk cll plan because there is no plan for b-pll

[cllady01 Former Volunteer in reply to Hidden]

I think that is "the same difference" to use a colloquial phrase. Your team is one with experience and while your case is different from the normal (if there is a normal CLL case) their task is to get you treated with the best med there is at this time for your situation.

Have you asked your Dr. and/or the connected speciality pharmacy about your specific situation? I would be surprised if there isn't communications going on to clear what is needed for "a high risk CLL plan".

Not all CLL is designated as high risk, nor do all Medicare Part D plans have the same policies and coverage so comparison of experience is not that reliable for easing one's mind that the med will be covered.

If there is a need for special coverage, you need to be in on the conversation--to ease the worry of the situation. Best wishes for a resolution that will help you.

[Hidden in reply to cllady01]

We keep going round and round on this. there are so few b-pll patients that to get an indication on a drug-example imbruvica- can't be done because not enough for a valid study. Just the way it is. However the few b-pll patients h i have been able to find -most use the drugs that would be used on high risk cll.

[cllady01 Former Volunteer in reply to Hidden]

Do you mean you and your Drs and the insurance company that carries Medicare Part D keep going round and round?

That is who you should be dealing with--no two systems of insurance are the same even in Medicare Part D--you have to get the Dr. to send a letter to the particular Medicare Part D company you use to ask for any exceptions---

Read your insurance companies booklet that you got at the beginning of this year to find out how to contact them for any "refusals" and for any necessary medicines not on their formulary/not FDA approved---the Drs. and hospitals have people who deal only with insurance situations. And the Specialty Pharmacy is part of that also.

You may find someone who has dealt with this situation already, but unless it has been cleared through the above process for your specific case, you can't count on it being what will happen with you.

TALK to you Dr.

[Hidden in reply to cllady01]

I haven't even gotten to that point. Imbruvica is working fine right now. I was just wondering for the future. I'd have to ask my doctor and insurance-which is medicare part d to tell me something that may never happen. i'm just interested. On this site people have already been thru stuff. makes it easier

[glkmel]

Hello, They had to ask if insurance would cover the two drugs and mine does. I haven't started yet. I'm still working on getting to clinic for the two day ramp-up for the multiple labs the first two days of the first two weeks for the planned increase. Then, can use a lab for monitoring close to home.

[kathypawpaw in reply to glkmel]

Dear glkmel Could you please tell us what Medicare Part D plan you have?

[glkmel in reply to kathypawpaw]

Regence blue shield blue cross.

[kathypawpaw in reply to glkmel]

Thanks so much! I will check my blue cross and blue shied options. Thanks for getting back so fast!