Calquence anyone?

[Sandlot]

Interested to see who is on Calquence and if you have found a prescription plan that covers it with Medicare.

[rafew]

Hi Sandlot. Affordability of these drugs is one of my big concerns. I have UCare along with my Medicare and it’s covered, but has a high co-pay. Fortunately I qualified for a grant to cover it through the speciality pharmacy needed to get the drug. I would think something like this would also be available to you. On a side note. I did upgrade my insurance coverage to better cover hospitalization once I started Calquence. You never know. Best wishes

[Sandlot in reply to rafew]

Thank you so much! I get my Calquence each month through Onco360. I am going to contact them and talk to my oncologist! I appreciate your response!

[Panz]

I am on Medicare and they contribute to covering and then I have a grant or two to cover the remaining amount. My Florida Cancer Specialists work on getting me the grants. They first go thru PAN Foundation and if there isn’t a big enough grant a available the go thru LLS for another grant. I don’t have any out of pocket expense. It also puts me in the donut hole with Medicare making all other Rx’s more reasonable that happens in either after the first month or into the second. Now we have Medicare and part D and F, plus we have United Health thru AARP. There is help out there as my doctor said there just isn’t anyone that can handle the cost of these big priced drugs and if you are u able to secure grants they go straight to the drug company! So you seek help from a knowledgeable person to get you set up with the right Medicare program. I know you want Part D a e I know Part F is no longer offered. Then you will want a supplemental.

I am just so happy you are doing well on the Calquence! I am too….about to enter my 7th month!!! My Calquence come via Fed Ex each month thru a speciality pharmacy.

Just take lots of deep breaths this will work out in your favor but is is a bit unsettling!

Panz

🙂🙏💕☘️

[Sandlot in reply to Panz]

Thank you so much!!! Yes! Unsettling is a good word! Calquence sounds like it has been a miracle drug for you, too! I am going to talk to my oncologist this week! I appreciate your response.

[Sandlot in reply to Panz]

How do I private message you? I am new to this site and my family calls me button-challenged! Lol! My other message to you didn’t make sense. Sorry!

[Panz in reply to Sandlot]

Could someone help Sandlot how to private message. I am as tech compromised as she is!!!

Panz 🙏🙂💕☘️

[BaseballGardener]

Check out AARP Medicare Rx plans; several of the options will cover Calquence. Visit myAARPMedicare.com. If you qualify, there are societies that can assist with the co-pay. Your pharmacy should be able to assist you with this process. The grants are usually limited by time and total cost.

[Sandlot in reply to BaseballGardener]

Thank you!

[BaseballGardener]

I think some people are getting confused on what they actually have for coverage. Medicare Part D is drug coverage, so when somebody says they have Part D plus AARP Medicare Rx, they might be thinking there are 2 separate plans. Actually, the AARP Medicare Rx is their coverage for Part D. Separately, there are medigap supplement plans which is additional coverage for Part B. Part B covers doctor's visits and procedures, not drugs. I think you mentioned in an earlier post that you are 64, so you don't qualify for Medicare at this point? You have to be 65 years old to qualify for Medicare coverage. Lastly, the bruising that you getting is an unfortunate consequence of the disease; there are issues with blood circulation. If your hematoology numbers look good, consider lowering the dose of the Calquence, and do physical exercise. Exercise will improve get your blood moving and should help with the bruising issues. Please discuss with your doctor.

[Sandlot in reply to BaseballGardener]

With the very best supplement plan I will have to pay $773 a month from what I am finding out. Not good. Yes, I do not qualify until November. Trying to run offense and get my ducks in a row and become as knowledgeable as to what is out there for me. Member PANZ gave some excellent insight as to what to do first. Thank you for your response.

[wizzard166 in reply to Sandlot]

Hey Sandlot

You would not pay $773/month for the best Supplement, which for you would be Plan G, so I'm going to assume that you meant that the best Medicare health plan (not Supplement) would have a prescription cost of over $700 for the Calquence. The top Medicare Supplement for you Plan G would only cost around $200 something per month depending on what State you live in. Supplements do not cover medications, they cover the 20% Medicare doesnt pay, and also the Part A Hospital Deductible per hospital stay, etc. When you get a Medicare Supplement you are also using Original Medicare, but then you also have to buy a separate Part D Rx plan to cover the medications. If you don't use Original Medicare plus a Supplement plus a Part D Rx, then you can use Medicare Advantage instead. Med Advantage plans include the Part D Rx built into them, and you don't pay a monthly premium for the Advantage Plan or the Part D Rx plan included with the Advantage Plan. The AARP Medicare Rx is a separate Part D Rx plan you might buy to add to Original Medicare and a Supplement. There is also an AARP Medicare Advantage PPO plan, and that would also include the AARP Part D Rx.

Anyway your cost for filling Calquence would be about the same whether you have it filled with a Medicare Advantage plan or a separate Part D Rx. The only difference would by the size of the Deductible, which is about $480 on most separate Part D Rx plans or between $150 to $250 with the different Med Advantage plans. Some of the HMO Medicare Advantage plans actually have a $0 deductible for Rx, but then you're living with the restrictions of an HMO plan.

Carl

[TroutFly]

I am starting my 4th month on Calquence. I have a Medicare advantage plan through Pacific Source. Calquence is covered under part d. My co-pay for the 1st month was about$3,000. After the first month my co-pay dropped to about $700 per month. My annual cost will be about $11,000. Astra Zeneca has a co-pay assistance plan with an income limit that is worth looking into.I hope this helps.

[Sandlot in reply to TroutFly]

The least expensive that I found was Silver Scripts. There would be the deductible plus the monthly amount of 700+. That is just so much! I think I will make too much for assistance plans but I am going to give all of everyone’s suggestions a try! 👍thank you so much for responding.

[wizzard166]

Hey Sandlot

You can get Calquence covered on almost any Part D Rx plan. Then too there are the Medicare Advantage plans that likely all cover Calquence too. The big difference to you will be deciding on whether or not you go with Medicare Advantage or Original Medicare plus buying a Supplement and separate Part D Rx plan. The Medicare Advantage plans give you the Part D Rx included in their package, and you also don't need a Supplement with Medicare Advantage.

There are many many more things to know about the difference in you choosing either Medicare Advantage or Original Medicare with a Supplement.

As far as how Medicare covers Calquence it will be pretty much the same regardless of which direction you go with choice of Med Advantage versus Original Medicare and a Supplement.

You will first have the Deductible on the Prescription which will be around $480 with regular Part D plans or around $250 with various Med Advantage plans.

After your annual Deductible on Rx, the various plans will charge you around $1450 in that same first month. This is because you go into the GAP in the first month, in addition to the Deductible. In the GAP you pay 25% of true retail cost. You actually enter and get out of the Gap and into Catestrophic Stage in the First Month.

Then after that all months will be in the Catastrophic Stage, during which you pay 5% of true retail cost or about $713/month

Depending on your income and assets you might be eligible for Medicaid. If you do qualify for Medicaid, you will be able to get your Medication for very little monthly cost. If you don't qualify for Medicaid, and qualifications vary by State to State, then you could get help with various patient assistance programs.

Carl

[BobCLL in reply to wizzard166]

I have been on Calquence for 6 years in a study, now its payback time.

My Wellcare Part D will not cover Calquence unless I have big problems with Ibrutinib.

I have never taken Ibrutinib,

Any suggestions on how to get around this???

[wizzard166 in reply to BobCLL]

If Calquence is not in the Formulary of your Part D Rx plan, then your Hematologist/Oncologist must request a Formulary Exception to add Calquence to the Formulary. His logical argument would be that you have been in a Clinical Trial for your illness with Calquence and it is too dangerous for you to stop it now. If it is in the Formulary, but they don't want to offer it unless you try Imbrutinib first, he needs to Appeal that decision using the same argument.

If your not sure if it is in the Formulary I can easily check it for you. Just let me know which Part D you now have.

Carl

[BobCLL in reply to wizzard166]

Carl,

It is in the formulary. Just denied because I have not tried Ibrutinib

I hope my doctor is able to make the very good argument, that the switch is not a good option.

The cost difference between the two drugs is only about $2000 month 15k vs 13

[wizzard166 in reply to wizzard166]

Bob

Sorry for the delay in seeing and replying to your answer. My wife and I flew Monday Morning (day before your reply) to Boston for my Six Month visit at Dana Farber. I live in South Florida, but travel to Boston every six months to be followed by the top person there. I'm now four and a half years into W&W, and hope each time to hear her say we can stay in W&W for another six months; which, is what we heard this time.

I turn the one day visit into three nights in Boston, to enjoy that city. Then we switch to some other city for another three nights. This time it was Manhattan for a Broadway show, the New York Ballet, and then Carnegie Hall on our last night. I turn travel to a serious medical appointment into a one week vacation. Every September and Every March.

Your doctor might be able to win an Appeal to go straight to the new Medication instead of Imbrutinib, if he can make a case that it is the only medication currently working for you and switching could be dangerous. Good luck.

Carl

[Sandlot]

Thank you so much for this information, Carl! I will not qualify for Medicaid. Over $700 is just a lot for a retired educator’s budget.

[skunkbay53]

Google Calquence patient assistance...We get my husbands through it. We did have PAN foundation grant but it ran out and there is a wait list for it.

[Sandlot in reply to skunkbay53]

Thank you!

[bhayes84]

I'm retired and on AARP MedicareAdvantage. For the 4 years I've taken Calquence I've had grant assistance. My onc told me he that none of his patients of modest means had ever had to pay the large co-pays. My PAN grant just ran out and I'm now getting it through the AstraZenica & Me assistance (though I heard later that HealthWell has grant money available).Good Luck.

[Sandlot]

Thank you!