Does anyone have information what the costs are for the different ADT meds
I am on Medicare Part D , I understand Lupron is a Tier 5 drug my copay is the first $415 then 25% of the drug. what i found on the internet a 6mo treatment is close to
$20,000 to $25,000 does Lupron come in a generic?
Medicare can be pretty confusing. If you're using Part D, I think that means you're on 'traditional' Medicare, as opposed to Medicare Advantage, where I think drugs are covered by the supplemental insurance company. I'm on traditional Medicare and went thru 13 months of Lupron therapy and never had to worry about paying for Lupron thru the Part D drug plan. Here's my situation: traditional Medicare with its premium ($135?) being taken out of my Social Security payment. My supplemental insurance is Mutual of Omaha, with a premium of about $150/month, and the part D drug plan is Silver Scripts with a premium of about $20 or so. And none of those require co-pays for treatment. The only deductible I've ever had to meet is the basic Medicare deductible of about $185/year. I was getting a Lupron injection every 90 days (well, I started with 2 weeks worth of Casodex pills and then had a 30 day Lupron injection, and then had an injection every 90 days for a year) - no extra cost for any of that and no dealing with the drug insurance company. I did get periodic 'statements' from the hospital ("This is not a bill" it would say) and I think each office visit and injection was about $2500 - but again, no out of pocket co-pay for me. After being on traditional Medicare for 3 and a half years, I'm impressed with how it all worked. That time frame included a biopsy, all necessary scans and tests and doctor visits, rp surgery with an overnight hospital stay - the 13 months of Lupron, AND 8 weeks of salvage radiation (the statements from the radiation hospital indicate that whole treatment was well over $100,000!). My total out of pocket for that whole time has been less than $1000 (not including monthly premiums). I'm considering switching over to Medicare Advantage this year, mainly because there is no monthly premium for the supplemental, I can get free health club membership, some dental and vision coverage, and a few other benefits. BUT, there are co-pays for everything and a large annual out of pocket amount. I've had such good luck with medical expenses so far that it's a tough decision, but I've got a few more months to think it over. Sorry to ramble but hope this info is helpful. Good luck with everything. Patrick
Patrick
Thanks for the information, i do have supplemental Part B coverage with AARP United Health ( Plan F) so far everything i had done has been covered with no out of pocket expenses including the $185 Medicare annual deduction. my supplemental Plan F is about $155/ Mo. and a drug Part D supplemental of $28/ Mo.
My understanding from your information is that my plan should cover this treatment. I will be finding out shortly
I was om Lupron (Eligard - generic) for 6 1/2 years and all I paid was $50.00 every three months for doctor's co-pay. I even had a group help me with the co-pays. I have United Healthcare medicare complete. United Healthcare sent me a letter in January 2019 saying they only will pay out $22,000. in one year for medication. My bill was $24,000, last year and they told me to include a $2,000. gift from them on my income tax. My costs were high, because I also have kidney, heart, and diabetes diseases. I no longer am on Lupron or any cancer therapy.
Jim
Thanks for the information and wish you well with the other health issues
I have a medicare supplement plan (F) not a medicare advantage plan , hopefully it is different
i read that most advantage plans have higher deductibles , not sure what my plan will cove and I am waiting for united health to get back to me
Yes, they will help you find the best plan for you.
Only certain states have Medicare advantage. When Obama needed states for Obama Care the Florida Governor voted YES if Florida got Medicare Advantage. I think 5 states did this, so check it out.
Dexter: I get my care from a community oncology practice (non hospital based) in Syracuse. A couple of weeks ago the practice sent out a notice that they would not administer any drugs (via injection or infusion) that they did not procure themselves. I believe some insurance plans were trying to get them to use drugs procured by the insurance company. So I think you're safe getting Lupron thru Part B rather part D. Anything that the doctor supplies and administers should be part B.
Joe
The other side of ADT.
Living with metastatic disease, long term ADT & crotch rot
