I have to go on Medicare part D since I was switched to Ibrance from faslodex. Apparently Medicare does not pay for cancer treatments in pill form . My question is which part d do you use. I have straight Medicare, so don't want to go with an HMO or Advantage plan.
Medicare part D: I have to go on... - SHARE Metastatic ...
Medicare part D
Written by
sevoia
To view profiles and participate in discussions please or .
Read more about...
41 Replies
•
You should be able to get a year supply of Ibrance free from PfzierMasy I ask why you do not want a supplement insurance?
Oh I see. How long have you been able to get the drug from Pfzier? I was on Medicare/Supplement/Drug plan but once on Medicare I was not able to get my drug covered. Pfzier did agree to give me meds for free for one year but that was it. I do live in the states, so different rules if you are out of this country.
I have only been on it for the 1st 21 day round. Just started the 2nd round
I started on 125 but aside from not being able to get out of bed, I had bad nose bleeds (in the literature but only 10% of people) so we reduced to 100 mgs and that was fine. How are you doing on the drug? I'm sorry but where has your cancer spread when diagnosed with MBC?
This is my second round of metastasis. In 2018 it was in my sternum, humerus and a few other bones. I started faslodex and it kept the metastasis at bay until a few months ago. It was in my C4 and femur. I was given radiation to my neck and am now having radiation to my femur. I was started on Ibrance 125(but was changed to 75 mg) letrozole and Xgeva every 3 months. I am having burning feet and my heels hurt when I walk. I am also dropping everything. Don't know if it is from the meds and if it is, which one
I am on IV taxol and that drug does cause neuropathy. I have a little in my toes but not hands right now. Not sure how I feel about starting nerve pain meds. I'll work with a a whole plant cannabis CBD first and see. I have noticed that episom salt baths with non aluminum baking soda and essential oils does seem to help for a while. But, not enough when this gets worse. What was the c4 radiation like? What were their reasons to radiate?
I was having severe neck and shoulder pain for months and finally went to my medical doctor about it. He ordered an X-ray which showed metastasis to my C4. The radiation itself is painless, except they strap your head down with a plastic mesh cover. I could not tolerate it being over my mouth and nose, so they kindly cut out that area. My pain went away after 3 or 4 treatments (I had 10) but then it hit my throat with such pain, I could hardly swallow my saliva, much less food or drink. That lasted for about 2 weeks. I am fine now and am enjoying the loss of 6 pounds.
Following this as I turn 65 in Dec though in my head I am 27! For the moment, I am staying on private insurance as I own my own company, but I will pivot at some point and I want the top coverage from a part D. Thanks for asking this.
Unfortunately the plan I have, I'm 71, has been cancelled because it covers too much. But, i would always say to buy the top of all of these policies and AARP has a great supplement--I virtually pay for nothing in the system.
I am on Medicare with a supplement plan and drug plan. Ibrance should be covered with your drug plan but the co pays are very high. The first month will be the highest but that will also put you into and out of the "donut hole ". After that the co pays are better but still high. Currently the Gov can't negotiate drug prices the way Insurance companies can thus the high co pays. You can look into the PAN Foundation for a grant that would help. It is based on income. If you go to Medicare.gov you can see all the drug plans available in your area.
Which drug plan did you choose
Wellcare Value Script. It is tricky to choose one. Some are better with my other meds but not Ibrance. Or better with Ibrance and not the others. Be careful about what tier the plan puts your meds in. Ibrance is always specialty but one of the cheaper plans put my other meds in tier 3 vs tier 2 for the other plans. This results in higher cost overall.
I have the original Medicare (no advantage plan) with. Supplement for part b. For plan D I use well care. In the beginning, it was expensive till I met my deductible, after that all was paid for. I used Pan Foundation in the beginning and they were wonderful and easy to work with. Even though I don’t use it now, I’m still in their system (no need to go through financial approval anymore) and can get assistance when next I need it.I live in Texas but I believe Well Care is in most, or even, in all states.
Take care, Melinda
Thank you . I live in Texas too
Your drug plan covers all the cost of Ibrance? The best I can find is 700 co pay after hitting catastrophic coverage.
Why did you choose Well care? I found it was not the cheapest for just Ibrance and letrozole
Is the PAN Foundation a federal program good in every state?
It’s a private foundation. I went online and applied. Sometimes you have to wait a bit to be accepted, I think it depends on how many they are helping at the time. The only financial info I had to give was my basic income each month. I listed how much my husband and I made in social security each month. I was then given a set amount (for me it was $4500.00) that I could use towards my med cost. When that ran out, I simply had to go back to them and say I needed more and I was given another $4500. Currently I don’t need them as I’m on Xeloda and my part b pays in full. But I’m in their system now, so if I ever need help again, I can just reactivate my account.Melinda
Thank you so much, Melinda!
I've been in Ibrance for about 3-1/2 years. For most of that time, it's been paid for by private grant money which my specialty pharmacy secures for me. You have to meet income requirements but your pharmacy or maybe social worker at your hospital can find outside funding. When funding was not available, Pfizer picks up the tab. I don't think you can plan ahead for funding in 6 months or whatever; it's whatever is available now. If Pfizer is paying for it now, they should continue to pay it as long as you meet their income limitations. I have part D, but it's still like $3000 a month which is more than I receive from my SS and pension.
The insurances I have checked into all cost over $10,000 a year including deductibles and co-pays
I'm a little confused by your response. Don't understand what you mean by "insurances".
If Pfizer will only cover your Ibrance for a year, there are other resources out there. I never dealt with any private funding foundations; my specialty pharmacy did everything.
I am talking about medicare part D. There are a lot of different options out there, and they are similar in yearly cost for Ibrance. I was just wondering which insurance to sign up for. If Pfizer keeps providing me with Ibrance, I won't need to use the part D, but I need to have it just in case and this is the time of year to sign up.
I have part D coverage through BCBS of Illinois - I'm guessing it's similar costs in other states (I assume you're in the US). It costs about $60/month. You don't have to pay $10K for part D. I'm sure the more you pay, the better the coverage for drugs like Ibrance, but the whole point is that private funding covers what part D does not cover for Ibrance. The part D pays what it pays, and the foundation pays the balance. Other than my monthly premium, I don't pay a cent for the Ibrance. The point is that a foundation is paying for what you cannot. If you meet the financial requirements for Pfizer to pay for your Ibrance, you probably should be able to get other outside funding, if it becomes necessary. Do you get Ibrance from a specialty pharmacy? Ask the pharmacist about how outside funding and part D work together.
That sounds like good advice. I went to the medicare web site for part D, put in Ibrance and letrozole as my medicines, and all the participating insurance companies came up with very similar quotes of $10, 000 a year including monthly payments and deductibles. So I am confused about not having to pay for Ibrance. I guess I need to make some phone calls
I don't mean to belabor this, but just for the hell of it, I went on a Cigna website (not Medicare site), put in all my 7 scripts including Ibrance and letrozole, and the most expensive plan was $62/month. Yes, according to the plan, yearly out-of-pocket expenses could exceed $10,000 in a year. But you wouldn't be paying that $10k+ with foundation assistance should you no longer qualify for Pfizer funding. Again, I would suggest talking to your specialty pharmacist for further information. I'm sure he/she can suggest an appropriate, affordable part D plan for you. I would buy a part d plan now, and when and if your Pfizer funding ends, you can apply or your pharmacist can apply for outside assistance. I was funded by several foundations for about 3 years, and never paid more than my monthly premium.
Thanks, that clears up a lot
I think oncologists are all different. I was on Ibrance and Letrozole and my onco said she needs to switch me to Faslodex instead of Letrozole. I am still on Ibrance though. I am not on Medicare although by age I would qualify. I get private insurance through my husband who still works. We are not on Medicare because I heard that Medicare would pay for just a little of Ibrance.
From my experience medicare does not pay for Ibrance at all.
Medicare doesn't pay for any drugs at all. I think some Medicare Advantage plans include drug coverage but that isn't the case with original Medicare. So you will need a supplement drug plan to have any drugs covered. Be wary of Advantage plans because coverage can be limited, especially with our diagnosis.
I am on Medicare Advantage through United Health Care. The 21 day supply of Ibrance costs me $650 a month, insurance picks up the rest. They increase the cost of pills periodically without any notice. Hope this helps.
Isn't this a catch 22? Yes, i was faced with that very situation and was looking at a $2400 copay for Ibrance. They do not give you a break if you're on Medicare...and very few Supplemental plans will cover the Ibrance RX with less than a 2K$ copay. But there are some. Please go to a a registered Insurance agent so they can run a comparison for you. I finally did get covered for meds but the monthly supplement costs me $330+ . Along with the cost of the Ibrance copay it's over $400 a month...but a far cry from what I would have paid otherwise, donut hole not withstanding.So please check before time runs out for you to make your selection. there are specialized but pricey plans that will help.
Thanks. Which plan did you go with?
Not what you're looking for?
You may also like...
Paying for Ibrance on Medicare
Does anyone know if Medicare Part D covers the cost of Ibrance?
Help needed with Medicare
I live in the US and I’m looking into Medicare Part D for my Ibrance and I need help determining...
What Medicare Supplement Plan & Rx Plan Covers the Most Costs for MBC Patients?
I need to make the decision to pick a Medicare Supplement Plan & Rx Plan (Plan D) as I lose my...
MBC Medicare Drug Plan
Does anyone have advice on Medicare Part D drug plans in the US? I am switching from Ibrance to...
Help with Medicare choices
Anyone on here on Medicare Advantage Program Parts A,B and D. Currently covered under my husband’s...
Ibrance expensive
Medicare 
FINALLY, APPROVED FOR DUAL COVERAGE OF MEDICARE WITH FULL MEDICAID
On Ibrance. Going on Medicare soon. Any Advice?
