Help with Imbruvica

[Sbestgen]

The best thing about turning 65, is that you can get insurance through Medicare. I have CLL and take Imbruvica The cost of Imbruvica is so high Medicare will not cover much. Does anyone know where I can get help covering this drug?

[HailMary-USA]

Your oncologist may have a financial person who can help coordinate funding assistance.

Also the specialty pharmacy which provides your drug may help.

Other members here will post links to specific organizations which offer assistance.

Best of luck to you.

Mary

[SofiaDeo]

The various drug companies have direct patient assistance, so does PAN (Patient Access network), and check out the American Cancer Society, the Leukemia and Lymphoma Society, GARD (the Genetic And Rare Diseases information center) plus possibly some state specific resources. Depending on your Medicare situation, if you are getting the drug run through your insurance (mine is supplied by the company and isn't run through Medicare) you may be in & out of the "donut hole" quickly. My Medicare Advantage Plan has a $6200? yearly out of pocket maximum so if I didn't qualify for free drug, at most I have to try to budget for is that. So far I have spent around $3000 a year in medical expenses, not counting the cost of my Medicare which I have automatically deducted from my monthly check.

The donut hole for 2022 is around $4500. There is time to change your plan (I think until the end of this month) if you aren't happy with your choice for certain circumstances. Speak with a licensed Medicare Insurance specialist in your state to see what options are available, and if they can do a cost-benefit analysis once you narrow your choices down. For example, I chose a plan that has a $350/day inpatient copay days 1-5, a $50 specialist copay, outpatient surgery center copays, $100 for an ER visit, and $300 if I need an ambulance. I have a PPO so I can go out of network at 50% coinsurance. Since I didn't choose a plan that has most all of this covered, it costs me less monthly. I don't have other disease states where I anticipate a need for a lot of hospitalization, or ambulance rides, and I save to cover specialist visits & if/when I need a hospital. Plus I save for newer tech lab stuff that either isn't covered yet or may never be, I expect I will have to pay around $1700 for the clonoSEQ I had done in Jan. I am planning my "repeat in a year" to be late Dec, and my cost will be around $700 max because I will have met my deductible and will only need to pay the coinsurance.

q1medicare.com/news/Article...

HailMary-USA also mentioned your oncologist, which is the place to start IMO. Especially in larger practices/specialists associated with research institutions, they will be very knowledgable about resources available.

[DawnRedwood]

I take Imbruvica and get help from the PAN Foundation and also get extra help from the Govt. because of income. Since I have those two and Rx insurance I don't pay anything, not even a co-pay. I did read on AARP that Imbruvica is one of Medicare's most expensive drugs, AND the price has increased over 7% to over $14,000/mo. (AND..........it's made in China!)

[tonyfrench]

I got a "grant" from Johnson & Johnson, and since I make under 500% federal poverty level, I get my script for free, my Oncologist financial office manager did the paperwork for me

[netspert]

FWIW, my Oncologist has connections to Charitable Foundations that cover the "Deductible" for my Imbruvica - over $10,000 a month! I suggest you look for similar support - and I see others here have made more specific suggestions. Best of Luck finding what you need.