Does insurance cover medications for CLL?

[Karate]

Hi, does united healthcare insurance through the gob cover for CLL medications ? Or what health insurance are covering for CLL medications?

[cllady01 Former Volunteer]

Is 'gob' supposed to be 'job' ? if so, your company Human Resources office personnel can give you the details of what they negotiated for in covering medicines.

[lankisterguy Volunteer]

Hi Karate,

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There are many different health insurance policies offered by United Healthcare, and whether the one chosen by your employer is a top of the line PPO or a low cost HMO (or anything in between) is important. As   cllady01 says, you should start with your employer's HR department to learn about the details of your employers specific policy.

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CLL often involves getting an expert hematologist at a major hospital and expensive lab blood testing several times each year - long before you may need treatment, so you may want to ask about how those are handled, what typical copays are required of the patient.

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When treatment is needed (that may be 2-5 years or more, in the future for you), most of us are prescribed either daily pills that retail for $120,000 per year and / or 6 infusions in a clinic that may retail for $10,000 each. For some insurance these different scenarios are handled very differently, and the copay rules may be different, so you should ask the HR department about those.

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We hope you can find some useful answers, but with the limited data we have so far, not much is available.

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Len

[Ladylin151]

Definitely, you should look into your specific coverage, no matter who is providing your insurance. Find out what your deductible and out of pocket maximums are. If you are not nearing treatment yet, you may be able to adjust those things when choosing insurance in the future. But also, when it comes time for treatment, most specialists will have at least SOME information on co-pay assistance, drug company grants, charity organizations etc. It will depend on the insurance coverage, your financial needs and what medication routines you are prescribed.

[Big_Dee]

Hello jammin_Me

May work. First question I was asked when I applied at MD Anderson CLL trial was what insurance I had. I have insurance through work and drug coverage is described by tier number. Cancer drugs are normally classified as tier 5, Specialty drugs. All over the map.

Since I am covered by Medicare and private insurance, it is a mess. Medical coding done by doctor's office is everything. For example, Medicare will not pay for more than 2 blood tests per year, (everyone knows how many blood tests we go through). If blood test invoice is submitted to Medicare before private insurance, they will not pay, and private insurance will not pay if item is not covered by Medicare. Private insurance will pay all blood tests if invoice is submitted to them before Medicare. Luckly my wife knows medical coding and goes through the Explanation of Benefits (EOB) in great detail. Due to doctor's office invoicing submission error, I now owe $60,000 US in CLL treatment costs. All the invoicing is now being resubmitted in correct order, because doctor's clerks automatically assume if you are retired, that Medicare is your primary insurance. Invoices are submitted to primary insurance first. All I can say is good luck. Blessings.

[Kingfish6 in reply to Big_Dee]

Hi.I've never had a problem with Medicare & insurance covering blood tests. I get at least 4/yr for CLL , & even more with other docs.I've found insuance plans are similar & acknowledged by the gov't. I have Plan Fplus w/BlueShield . United has similar but called something else. Generally, much of the cost issues relates to whether the drug is dispensed/issued in a hospital vs. external pharmacy like the BTK's.

[Kingfish6 in reply to Kingfish6]

apologize, meant PartD.

[Big_Dee in reply to Kingfish6]

Hello Kingfish6

I do not have Medicare supplement insurance but separate private insurance through work. I have dual coverage. My private insurance pays all my blood tests, issue is if invoice is submitted to Medicare first as primary insurance, then private insurance will not cover.

[Gisygirl]

I have a Medicare RX Plan that pays most of the prescription pills I take for the CLL.. but the deductible and copay run into ALOT of money so I have a grant. You doctor's office can help you reach out to companies that can assist you. My oncologist told me that eventually, these very pricy drugs ( $13,000 a month) will go generic which will bring the cost down. But between the insurance and the grant, I have $0 out of pocket for this medication.

[Agiledog in reply to Gisygirl]

Gisygirl. All eventually go generic? Maybe. Hope these drugs don’t go the way of many big pharma moneymakers———just before patent expires the company tweaks an irrelevant molecule and gets to call it a new drug awarded an extended patent. Bud

[Rovering_Rose]

When I had treatment, some of my treatment was covered under the medical portion of my insurance and some of it was covered under my pharmacy part of my insurance. Call united and ask how your treatment is covered. They may have programs to help you navigate treatment. Your hematologist's office may have a financial person to help you navigate treatment as well. Also, go to lls.org. They have a lot of resources, including co pay assistance, if you qualify. A lot of drug companies have co pay assistance as well.