Help needed with Medicare

[Shar313]

I live in the US and I’m looking into Medicare Part D for my Ibrance and I need help determining what coverage I need that will pay for it. I understand it’s $10k a month and it immediately falls into the donut hole after the first month and then I’m responsible for about $1500 per month. I don’t have that much money. Any suggestions are appreciated. I figure there are others who have already gone thru this and can give me advice. Thanks 😊

[Betbop]

Because of my financial situation my nurse co-ordinated was able to get me into the Phyzer plan for medical assistance program. Check into this it helps so much.

[Shar313 in reply to Betbop]

Thanks, I’ll look into that.

[Southside25]

I have limited income and have no chance of paying for Ibrance. My specialty pharmacy has been finding me financial assistance over the almost three years I've been on Ibrance. They cover what Part D does not cover; I haven't paid a cent. I would think your doctor or pharmacy could help you find find financial assistance through various organizations or directly from Pfizer. I assume your onc. is associated with a hospital; perhaps a hospital social worker could help you find funding.

[Shar313 in reply to Southside25]

Thank you for your suggestions. 😉

[USIrishcolleen]

Shar313,

I also live in the US, and have limited income. Ask your oncologist about a federation at the hospital that helps cover part, or all of the cost of Ibrance. I was lucky to not have to pay for the 10 cycles of Ibrance that I took. Ask your oncologist.

Best,

Colleen

[Shar313 in reply to USIrishcolleen]

Thanks Colleen. My oncologist handles this pre-Medicare so I’ll ask about it while on Medicare. The cost is totally unreasonable IMHO. Sharon

[Lilykristymichael]

My oncologist’s office at the Univ of Mich takes care of this for me. There are grants that will pay for your portion. I have no idea how this is handled but am so grateful that my medical team takes care of it for me. Talk to your doctor and see if they can help you. Unless one is very wealthy I don’t see how anyone could afford this medicine. I will say a prayer that you can find the help you need. I have never had to pay a dime for mine.-Madlyn

[Shar313 in reply to Lilykristymichael]

Thanks Madlyn. I’m going to call on Monday.

[Maddyandherkittens]

I have been on Ibrance off and on for 2 years and the specialty pharmacy at my Oncologist's office at the University of Rochester NY has found grants to cover my costs (Ironically some are run by the drug companies.) A few times my insurance United Health Care has covered it but that put me into their "catastrophic" category (sailing past the donut-hole) and the rest of my meds were a $3.00 copay all year. I know each situation and insurance is different, but you should not have to pay for this! Best of luck and prayers to you and I hope this will work out for you. Hugs from Maddy

[Shar313 in reply to Maddyandherkittens]

Thanks Maddy. I’m feeling the love and I know this will work out. ❤️Sharon.

[hdhonda]

Shar,Please talk to Pfizer or someone in your oncologist office. I may be wrong but it is my understanding that Pfizer will not help if you are on a federal government insurance plan and Medicare part D would fall in that category. The important thing is for you to talk with someone who knows for sure and how to guide you around. I wish you the very best. You need to talk with someone in the field. Guidelines vary from state to state. Blessings, Hannah

[Shar313 in reply to hdhonda]

Thanks Hannah. I’m planning to call my Onc pharmacist on Monday.

[Kaydub]

My specialty pharmacy told me Pfizer has a copay card program but I don’t know if it works with Medicare.

[Shar313 in reply to Kaydub]

Thank you. 😉

[Garnet131]

I am retired, single at 73 and have Medicare along with a supplement drug coverage from Humana and have been on Ibrance for over 3 years (on 42nd cycle). Currently my monthly Ibrance cost shows up as $14,940 a month (was about $12,900 when I started) with a co-pay around $700. My oncologist's office connected me with a grant at the beginning that covered the co-pay. When that grant was due to expire, Walgreens Community Pharmacy (supplier of my Ibrance) found a new grant, and I have had various grants since that time. At one point when no grant money was available, the social worker at oncologist's office helped me apply for assistance from Pfizer, and Pfizer sent the Ibrance to me directly until new grants were available. Thankfully, in all this time, I have never had to pay anything for the Ibrance. It is definitely a little nerve wracking when a grant is due to end, but so far assistance has been there. That time is here again since my current grant expires in early March, but at my last order when I mentioned that to Walgreens, I was told that in February they will be searching for new funds. I hope this is reassuring to you.

[Shar313 in reply to Garnet131]

Thank you for sharing your journey. I will keep all of this in mind to see if I can find the grants. 😉

[Buffwright]

I use Silver Script plus for Part D. The first two months of the year until I reach my max out of pocket were brutal. After that, most policies provide that you’ll pay 5% of the cost. I’m on Piqray. I pay $860 a month!

[Shar313 in reply to Buffwright]

Isn’t that crazy? Why do these drugs cost us so much? Thanks for sharing your experience.

[library2019]

My social worker at the hospital found a cancer foundation that helps pay for the chemo check with social worker I have been very lucky getting help

[TammyCross]

Just confirming that Medicare Part D does not in any way affect the assistance you can get. I am on Pfizer's patient assistance program, just signed up for 3rd year. Have never paid a penny. This year when I tried to re-apply, Pfizer send my application to a specialty pharmacy. Someone called from there and said he could get grants to cover 100% of the cost. I told the NPs who work with my oncologist. They were shocked. Within an hour, I was back in the patient assistance program. I don't know what they did, but your oncology practice should have told you about this program and helped you enroll. They submit the form. Even if you wind up on grants, Pfizer will help you get them.

[Shar313 in reply to TammyCross]

Thanks Tammy, I’ll give them a call.

[Shar313 in reply to TammyCross]

Hi Tammy, Did you have an income limit with the patient assistance program? I called my pharmacy and they are aware of a Pfizer grant which requires your household not make more than $85,000 per year which may cause me a problem.

Sharon

[WordNerdSharron]

Hope you have found some help. If not, here's a resource that will help you identify options: drugs.com/price-guide/piqray

Good luck. It is so stressful managing the financial side of cancer--one thing we don't need at this time.

[Shar313]

Thanks Sharron.