Please help me sort this out!

[Jamie724]

I am new here and starting Ibrance next week. I am working and have insurance but as of 1/1/2019 I will be on medicare in Mass. Is there anyone out there in this situation? I am trying to find the best Part D medicare plan but it is hard to get any information on Tier 5 drugs. Any information would be helpful at this point.

[Clair19]

Hey and welcome. I’m in Ga on Medicare. You need to see if your State has Grants. I don’t know where you get your treatments or oncologist. My oncologist office does everything for me, and it pays for my medicine. Thank God because my monthly drug bill is over 30k. I take Faslodex and Verzenio, there is no way Medicare would pay that. If no grants depending on your meds the drug companies have programs. I mean even if you make over 100k no one can afford this medicine without help. Good luck and keep me posted.

[BeckyinMaine in reply to Clair19]

I’m with Harvard Pilgrim Stride Plus. Overall it’s very good but I haven’t tested the drug portion yet . Good luck

[JBirdnut]

Hi Jamie. My answer is similar to Clair19. I am on Humana Advantage in Louisiana. The Ibrance was covered by the insurance, but my copay would have been$2000+ per month. I went through a specialty pharmacy at Ochsner in New Orleans and was put on a grant that pays the copay. I pay nothing! Turns out the copay is 500+ but can't afford that either. The grant pays the entire copay.

Also, as Claire19 stated, the drug company will work with you to get you the Ibrance (or other expensive drug) for a very small copay or free. Just have to prove that you have insurance that is picking up their share of the cost. This is an option if you don't get a grant. Either way, you will be okay...no or very little copay.

I didn't know that my Dr's office had 2 nurses that take care of finding a low cost option for the patients until after I had found it on my own. So, ask your Oncologist who in the office helps with specialty drug costs and have them do the search.

Don't worry, you won't have to pay thousands of $$$. Just take care of yourself!

Good luck with the Ibrance treatment. It is working great for me. I have been on it since January 1st this year. Liver spot is gone...gone. All 3 bone lesions are much smaller and there is evidence of bone regrowth.

Janine in Louisiana

[Selmac]

I'm on Medicare. My specialty drugs like chemo pills go directly through Humana instead of the pharmacy. It's mailed next day to me. I have a patient advocate grant. They pay my coinsurance and Humana pays their share. I was in and out of the donut hole in January so all my other prescriptions are cheaper now. Pharmaceutical companies can give you the name of a patient advocacy company to call.

[Garnet131]

I am retired and on Medicare, plus separate Medicare supplement and drug (PDP) plans that I pay for. I started on Letrozole and Ibrance back in October. The Letrozole comes from local pharmacy with minimal co-pay of $3 or $4 under the PDP. At first I got it monthly, but now they do 3 months at a time.

For the Ibrance, my oncologist's office initially set up a $5000 grant through the Patient Advocate Foundation. I had to answer a few questions and provide copy of income tax return showing adjusted gross income. When the funds from the first grant were used up in January, the specialty pharmacy called to verify my income and set up a new grant with the PAN Foundation. These are not state grants, as I'm in Wisconsin and the foundations are located in Virginia and Maryland. The Ibrance is delivered to my home monthly from the specialty pharmacy. Just received delivery yesterday; it comes with the same type of receipt as all prescriptions showing "Retail Price $13,553.69 Your insurance saved you: $13,553.69" with $0.00 in the Payment Due box. The whole process has been seamless. My suggestion would be to start with your oncologist's office. I'll admit that I sometimes have scary thoughts and wonder what would happen if I'm suddenly told no grants are available, but mostly I thank God and trust in His provision.

[Sjjohnson52 in reply to Garnet131]

I am in North Carolina and in a similar situation. I am waiting to see if I can get assistance. My copay is $2800 and of course I can’t afford that. Hope to hear something soon.

[Garnet131 in reply to Sjjohnson52]

Follow up with your oncologist's office if you don't hear soon. Doctor generally wants to get started with Ibrance asap.

[PJBinMI]

If you are being treated at a cancer center or large practice, there may be a staff member who knows local resources including insurance plans. I have a medicare supplement thru my last employer and have had coverage for everything I've needed. My Ibrance co pay was $35 a month but I didn't tolerate it well. I have heard good things about AARP's United Health Care policy but would suggest checking into details for any policy being considered. It's a shame that we don't have better medical insurance for everybody!