calquence

[Skidog]

my wife has to start ob calquence. She has WellCare part D for prescriptions. They approved it then we were told it was $4,000 a month. Her cll doctor applied to astra Zeneca for help. They told us zero copays. And that calquence wills ship from MedVantix. It’s been nearly two weeks and no word from MedVantix. We keep calling as does my doctor. We even call AstraZeneca. Still waiting.

[anon52]

I am receiving my calquence from AstraZeneca. Here is the phone number they sent me if I need assistance 1-800-292-6363. Hope this helps.

[Skidog in reply to anon52]

Thanks AZ has approved the calquence but it has to come from MedVantix, the specialty pharmacy. Monday I’ll get back on the phone and call AstraZeneca and the doctor.

[bkoffman CLL CURE Hero]

Usually drug companies can NOT help cover the cost of drugs for those with Medicare. Look to LLS and Pan Foundation, though they usually have income limits. We have a useful list of those offering financial help on our website at: cllsociety.org/living-with-...

Stay strong, we are in this together.

Brian

[lankisterguy Volunteer in reply to bkoffman]

I very rarely disagree with bkoffman, but

I was on Medicare Part D and Genentech used MedVantix to ship Venetoclax to me each month for 6 years.

This bypassed my Part D (e.g.: Welcare) and was sending the drugs to me at no cost to me or my Part D insurance. So the drug company apparently was avoiding the Medicare rules about discounts and copay assistance by giving the drugs for free.

I found MedVantix to be competent and efficient, so I encourage you to call them directly until you get a confirmed ship date.

AstraZeneca may have issued a case number for you and a phone number to reach Medvantix.

The people that answer the phone will likely mention both AstraZeneca and Medvantix in their greeting. (My calls were always answered: "Genentech Access to Care by MedVantx")

They usually ship FedEX overnight so it should arrive within 24 hours.

Len

[bkoffman CLL CURE Hero in reply to lankisterguy]

This is news to me and seems to circumvent the Medicare rules. I wonder how they do it. Thanks Len

[lankisterguy Volunteer in reply to bkoffman]

The prescription was "off label" since Venetoclax was only approved for 17p deletion in April 2016, and in June 2016 with my Tri 12, my Part D insurance would not cover it, so Dr. Furman contacted Genentech and got approval for the free drug.

Len

[SofiaDeo in reply to bkoffman]

I have Medicare, and I get my Venclexta covered by Abbvie. MedVantix is the shipping pharmacy.

Call MedVantix, see if they have the Rx on file. If not, see if the doc has sent everything to Astra Zeneca. Then see if AZ is acknowldeging receipt, then ask *them* what the hold up is. I am not familiar with AZ process, but for Venclexta it is: doc fills out paperwork to drug company and also sends an Rx to the main insurance company, once drug company sees that main insurance will pay (and thus the patient qualifies), drug company tells Medvantix they will pay. The Medvantix pharmacy then needs to get the Rx from the doc if AZ doesn't transmit it along.

[Skidog in reply to SofiaDeo]

thanks. I’m making progress today

[SofiaDeo in reply to Skidog]

Be aware MedVantix will likely use an overnight Fedex, someone over 18 must be home to sign for it, and you have to give Fedex driver the ID of whoever is signing for it, to scan in before whoever signs for it. In my area it's the 9am-12pm "guaranteed delivery" slot, and only once was it late after 3pm. So at least you won't have to wait at home all day long.

[Skidog in reply to SofiaDeo]

thanks. I just got am email from AstraZeneca that MedVantix will ship calquence today and arrive Wednesday

[SofiaDeo in reply to Skidog]

Yay! So happy this finally got resolved. FWIW, *Get Refills* as soon as you can. There will be a note on the label saying "refills after X". The idea is to get a full month extra on hand. IDK where your Medvantix location is, they have a few around the country, but I had problems with Fedex as well as the pharmacy city being shut down a few days due to weather last winter. There is generally a 2-3 week lag time from when you call in for the refills. So do *not* expect Medvantix to operate like a local one, with only a few days notice for a refill, you need to plan ahead.

[Skidog in reply to SofiaDeo]

That’s great help. Thanks so much.

[cllady01 Former Volunteer in reply to bkoffman]

WellCare paid the bulk of the payment for Venetoclax. The Pan Foundation grant was used to pay my share. A grant given to me for a specific purpose and my use of it for the purpose should not be against any law.

I got a letter from Wellcare after my treatment stating they would no longer be paying for Venetoclax. I have original medicare.

I can certainly understand that an insurance company that paid monthly the amount shown for a year would not be feasible for many patients--nor for longer than a year.

I plan to wait until next year to explore any possibilities for further when needed assistance with Part D insurances.

[may04cll]

For those of us on medicare , why can't drug companies help with financial assistance ? Is that federal law perhaps ?

[DeeDeeBird in reply to may04cll]

I wonder about that too. This is what I found on NPR; “Under the federal anti-kickback law, it's illegal for drug manufacturers to offer any type of payment that might persuade a patient to purchase something that federal health care programs like Medicare and Medicaid might pay for”. Here’s the link npr.org/sections/health-sho...

[Skidog in reply to DeeDeeBird]

Thanks. I think this law has to do with using brand name drugs instead of generics. Acalabrutinib is made and sold only by AstraZeneca as calquence. There is no generic made yet. AstraZeneca assistance program has agreed to give us calquence with zero out of pocket expense. So AstraZeneca is taking whatever Wellcare pays and is kicking in the rest for free.

[SofiaDeo in reply to Skidog]

No, I believe the med will not be run through your insurance, or contribute to your donut hole. At least, it's not in my case. I think that is how they can offer the free med. No one can offer any financial incentive *when items are being run through the Medicare insurance system*, but if Medicare isn't being billed at all, the law doesn't come into play. So even though a Prior Authorization was needed through your insurance in order to get the drug, you won't see any instances of the drug being filled in your Medicare insurance records when you look at your paperwork/account on your insurance website. Thus, no one can help with copays when running a drug through the Medicare system. But there's no law saying a patient *must* use Medicare to pay for stuff. In the US, people with insurance always have the option to not use the insurance. So Dr. Koffman is correct, no one can help pay part of a Medicare copay. But we always have the option of not using the insurance.

[Skidog in reply to SofiaDeo]

Thanks. WellCare , part D, did approve the calquence . We’re not privy to who’s paying what for it but I appreciate your information . I’m not going to inquire further as AstraZeneca approved calquence for free as it should arrive by fedex tomorrow . What you say makes sense . Thanks again

[SofiaDeo in reply to Skidog]

Right, my understanding is that the drug company looks to the insurance company approval as verification the med is being prescribed appropriately. Instead of doing all the due diligence themselves, and having to keep all those records, and follow HIPPA, etc. My insurance records note a drug PA approval, but nothing ever filled. The Rx is totally outside their system other than the PA.

[cllady01 Former Volunteer in reply to SofiaDeo]

See my reply to Dr. Koffman.

[cllady01 Former Volunteer in reply to DeeDeeBird]

That applies to only to discount coupons maybe. Look at the Advantage plan ads that have inundated the TV screen--those are incentives to purchase something that the federal healt hcare programs might pay for--though I suspect the pay goes to the physicians in that are the ones you have to see.

[lankisterguy Volunteer]

I very rarely disagree with bkoffman, but

I was on Medicare Part D and Genentech used MedVantix to ship Venetoclax to me each month for 6 years.

This bypassed my Part D (e.g.: Welcare) and was sending the drugs to me at no cost to me or my Part D insurance. So the drug company apparently was avoiding the Medicare rules about discounts and copay assistance by giving the drugs for free.

I found MedVantix to be competent and efficient, so I encourage you to call them directly until you get a confirmed ship date.

AstraZeneca may have issued a case number for you and a phone number to reach Medvantix.

The people that answer the phone will likely mention both AstraZeneca and Medvantix in their greeting. (My calls were always answered: "Genentech Access to Care by MedVantx")

They usually ship FedEX overnight so it should arrive within 24 hours.

Len

[may04cll in reply to lankisterguy]

So you were on Medicare Part D . If not presently , what are you using now if I may ask? thanks

[Skidog in reply to may04cll]

my wife has WellCare for the part D prescription plan.

[lankisterguy Volunteer in reply to may04cll]

I was and am currently on ExpressScripts now called Wellcare Medicare Part D, but no longer on Venetoclax.

When I started on Calquence the NYP Queens Pharmacy arranged for Wellcare Part D to cover most of the cost and LLS.org to cover my copay.

When the LLS grant expired then NYP Queens Pharmacy obtained a grant from Healthwell Foundation for the copay.

I checked medicare.gov/plan-compare/#... to confirm that Wellcare was still the best plan for me in 2023.

It was fine for me but my wife's Eliquis prescription went up significantly so we changed her to Aetna Silverscript to save $900 next year.

If you haven't checked your 2023 costs yet, you have only until Dec 7 to change plans

Len

[Skidog in reply to lankisterguy]

We just got an email from AstraZeneca that fedex will pick up calquence today and overnight it. WellCare approved it . I don’t know who is paying for calquence . If not WellCare then AstraZeneca is giving it to us for free. If so, how do they make money on this medication?

[lankisterguy Volunteer in reply to Skidog]

They don't make money directly from dispensing free drugs, but they do get good PR and probably take a tax deduction for it.

When I worked for a Pharma company I learned that taxes and research / admin costs /advertising were the top costs that were managed. Raw materials and labor to produce drugs were almost insignificant. So the cost of sending you a bottle of pills is trivial, but the benefit of a tax deduction and PR advertising is where they "make money".

Len

[Skidog in reply to lankisterguy]

interesting. Thanks for the information.

[beenthere2X in reply to Skidog]

WellCare is paying for a part of it, I assume, like Humana is for me. Another name for this is "discounted to insurance". I'm pretty sure Astra/Zeneca is still making a lot of $ on this. I "think" it is what they call a "Tier 4" (specialty) drug, and insurance pays, say, 60% of the cost. I don't think AstraZeneca is giving it away except maybe to those who are uninsured.

[SKINOW]

About to start Acalabrutinib myself. Where do you ski?

[SofiaDeo in reply to SKINOW]

Oooh yet another skier! I've been in Keystone since after Thanksgiving, until the end of this week. We got season passes, and have 2 more trips planned. I am looking at a third because this one is going so fabulously. But January is crazy expensive.

We are moving out of Taos and really won't have much access to there. FIL refuses to keep the house up, I find house cleaners but he keeps firing them/refuses to plan the 3-4 hours a week to let someone clean. Since we both have gotten MRSA there, and some other problems, we are choosing to stay away instead of this continuing problem. It's a lovely mountain and I will miss it.

We are planning relocating to Routt County, for Steamboat, which is actually my favorite in Colorado. I've skied most everywhere in CO, including the small day places. I don't really like the Sierra Nevadas or East Coast snow. I learned to ski in MI and PA. The only areas in the US I think I haven't skied are Utah, Idaho, and outside the lower 48 plus the Pacific Northwest. Jackson Hole and Montana are too remote for me anymore, I want access to good medical care.

[SKINOW in reply to SofiaDeo]

I live in Denver and have a house in Vail. I live to ski. CLL is challenging my endurance a little. I am anxious about meds. I would love to turn with you. I feel a connection. Could and would gladly host you and FIL. I just added my cell phone and the site stopped me. Not sure how to connect.

[SofiaDeo in reply to SKINOW]

PM me, send an email or cell# that way. This is an unlocked post, so private info not a good idea or even allowed. I am in the Springs and my specialist is Dr. John Burke at RMCC Aurora. I have also been seen at UCHealth Anschutz. Each place participates in different studies, so I have a broader access.

[SKINOW in reply to SofiaDeo]

What is PM?

[SofiaDeo in reply to SKINOW]

The Chat function serves as a Private Message (PM) or Direct Message (DM) which is not viewed by others. On a browser it runs along the top with My Feed, My Hub, etc. I don't use the app so not sure where it is, in there.

[AussieNeil Administrator in reply to SofiaDeo]

SKINOW and SofiaDeo,

How to compose, archive and report chat messages

support.healthunlocked.com/...

How to view chat messages

support.healthunlocked.com/...

[Pin57 in reply to AussieNeil]

?s … In regards to archived chat(s) …

(1). If you archive a chat you initiated, can the person you were chatting with (they still see that chat/messages trail) provide a future reply in that chat? n if sowill you see it (and will all the previous chats then show up too?)?

or … have you “blocked” that person from replying again to that chat by archiving that particular chat? I’m guessing no “blocking” is happening, right?

(2.) Also, if you are the recipient of a chat and decide to archive that chat trail, will you see a future reply from the initiator of that chat and if so will all the previous chats also pop-up?

Just Curious

[AussieNeil Administrator in reply to Pin57]

Archiving a chat just removes the reply from your display. It will reappear if the other party replies. Muting a chat both removes that chat from your display and does so until you unmute the other member. You can restore the display of a muted message by visiting the member's profile and unmuting them from there. See: support.healthunlocked.com/...

Neil

[Pin57 in reply to AussieNeil]

thanks!

[beenthere2X]

I also just started Calquence, obtained from the same pharmacy. If AstraZeneca/AZ&Me approved your financial assistance request, then the next step is for your doctor to send them a prescription. If that has been done, then continue to check the AZ&Me web site for the status of your shipment. I don't think talking to them on the phone does much good, as you only get a person telling you to wait. If your status on the web site is "Shipment Pending" or something like that, you should get your two bottles (60 days worth) soon.