Employer's insurance vs. Medicare for Imbruvica

I am on my employer's Blue Cross Blue Shield plan which has a zero co-pay for Imbruvica Other aspects of the BCBS plan are lousy but since Imbruvica retails at over $12k per month, I don't think it's worth switching to Medicare yet. My monthly deduction for my BCBS is $112. But the annual deductible is $3500. I am asking my HR person tomorrow if I can add Medicare to my private insurance until I retire late next year.

However, I see the high cost for Imbruvica on Medicare Part D. The specialty pharmacy that provides my Imbruvica was no help when I asked about Medicare costs. I see what another poster here said about paying $6000 for the first two months and $1218 the next few, then back to $6K. I think my post-retirement income will be too high to qualify for help, judging by the admittedly little research I have done. Any suggestions? Thank you very much.

[Hidden]

i get imbruvica on medicare part d. the ENTIRE yearly co-pay is 10,000 dollars.Most people don;t understand how part d works including the so called professionals at the specialty pharmacy and doctors offices. I am a retired retail usa pharmacist.

this is how it works . it is based on calendar year and resets in January. because you have to get thru the first 5100 dollars which includes the donut hole BEFORE you the get to the 5 percent catastrophic it confuses people. by co-incidence i started my fills jan 7 2019-yes this year.

My first 28 day pack was 2500 dollars jan 7. then every filling has been 623 dollars which it will stay until next Jan 1 when it starts again..since the fills are for 28 day packs a total of 13 will be used. I figured it out to just slightly below 10,000 dollars. getting assistance for the co=pay is a different issue

THIS IS AN ADDITION TO MY POST>

January is a HARD reset everyyear. IT always hapen Jan 1. So it is POSSIBLE for someone to start on Imbruvica in DECEMBER and pay 2500 hundred dollars and then have to pay 2500 dollars in January because the calendar year started again.. It is CALENDAR year and NOT 12 months.

[Hidden in reply to Hidden]

Thanks for the info. Another reason the U.S. health system is so screwed up.

I am in partial remission and hoping for full remission before I get screwed by the system. My oncologist wants me to try Rutoxan but my plant-based diet is working wonders and I hope not to need it.

[MsLockYourPosts Passed Volunteer in reply to Hidden]

Rituxan monotherapy is not a usual approach for CLL, though it is occasionally done. Is your doctor a hematologist with a special interest in CLL?

[Hidden in reply to MsLockYourPosts]

He’s a highly regarded oncologist but with no special CLL interest I’m aware of.

[MsLockYourPosts Passed Volunteer in reply to Hidden]

Is your doctor adding rituxan to Imbruvica or talking about using it instead?

[Hidden in reply to MsLockYourPosts]

Good question that I’ll ask him tomorrow. I believe adding it though,

[HopeME in reply to Hidden]

Highly regarded oncologists know a fraction of what good CLL experts know regarding blood cancers. Don’t be lulled into a sense of false security with a take charge oncologist. I fell into that trap and it was a colossal mistake. If you aren’t close to a major cancer center explore a phone consult with LLS.

[ronbecker]

Exactly my wife’s experience with copays and monthly costs. Her wbc went nearing 300 that her oncologist had her do an IV of Gazyva to drop it down. Praise the Lord she had two infusions and that was it. WBC normal and stayed there. We stopped imbruvica last December and never restarted it. PS also a retired retail pharmacist 👍

[HailMary-USA]

Matt, please be aware that if you do not sign up for Medicare Parts A and B within 6 months after becoming eligible (usually age 65), you will likely face restrictions on your Medicare options and may be forced into a Medicare Managed Plan/ HMO (with limited and unfavorable coverages). This happened to a friend of mine several years ago.

My husband and I have a BCBS Medicare Complement plan which has always provided nearly 100% reimbursement of all prescriptions (max out of pocket for each of us is $600 Annually including deductibles--yes, very blessed!) This plan is a supplement to Medicare Parts A & B; with no Part D needed.

I have not tested the plan's coverage of any cancer treatment drugs.

You really need to consult a health insurance / Medicare expert, or investigate directly with Medicare--ASAP.

Best wishes to you from Mary

[HailMary-USA]

P.S. Also, your corporate Human Resources person should be able to tell you if and how you can convert your existing group BCBS plan into a Medicare Complement/ Supplement Plan offering similar coverage...when you enroll in Medicare while you are still working.

[shoshanaz]

I am on my husband's (retired) federal BCBS plan and also on Medicare. We enrolled in both because it will cover just about all my co-pays. Medicare pays what it does, the BCBS picks up most of the rest. BEFORE retirement, BCBS would pay first and Medicare after. IF you do that, make SURE that your employer and you notify the Medicare benefits coordinator of change of status when you do retire. We had a really aggravating time with that status, and a lot of bills needed to be re-submitted. All was paid, but it took up a lot of my time on the phone.

[Rose_fancier]

Ivotedfornixon, I’m confused. You said it is $5,100 to catastrophic phase but your January, first month, fill was only $2,500. Did you have other medication expenses that put you into catastrophic the first month? I would have thought your first copay would have been $5,100.

[Hidden in reply to Rose_fancier]

I was surprised also-but then i read my listing from medicare that came a month later. It appears that the very expensive cancer drugs under a reform to part d 2 years ago passed by congress both shrinks the donut hole AND forced the maker of imbruvica to match my first payment and got me past the 5100 dollars on the first fill. I do not know how many years this will last . without these adjustments the part d yearly co-pay would be about 12000

[Rose_fancier in reply to Hidden]

Thanks for explaining. I’m a looong way from treatment still, so who knows what coverage will be in place then.

[virdieblue]

My flip answer is to keep working- You can get an estimate on line to see what your co-pay will be. Forewarned...

Virginia