Does anyone have advice on Medicare Part D drug plans in the US? I am switching from Ibrance to Piqray in November and all 24 drug plans for my area show an out of pocket cost for me at $60K/ year! I cannot afford $5000/ month for just one drug so I am in the process of applying for manufacturer's assistance which Pfizer provided for Ibrance. In the interim, I canceled the drug plan I had signed up for and am continuing with my private insurance.
For all the people in the US who are 65 years old or older with cancer, I have to believe people have found other avenues to pay for therapeutic drugs. Thank you for any light you can shed!
Suzanne
Written by
ClarenceO
To view profiles and participate in discussions please or .
I was on Ibrance for about 3 years. I live on SS and 2 small pension and obviously could not cover the cost. My specialty pharmacist was able to procure private grant funding for maybe 2 years, When that ran out, I was approved for manufacturer assistance. I am also transferring to Piqray and my specialty pharmacy has processed the request to Novartis for their assistance which has been approved. Do you have a specialty pharmacy or maybe a social worker at your hospital? They should be able wade through the various sources of financial assistance.
thank you for the replies. Yes, I applied immediately to Novartis for assistance under my current insurance after learning that my specialty pharmacist is prohibited from applying for assistance until after my Medicare starts. Seems like a policy that is backwards - buy first then we’ll tell you what the cost is. I’m trusting that Novartis will approve just as Pfizer did for Ibrance and Xgeva. The 2024 Medicare drug cap is a welcome change.
You should hit catastrophic coverage after the first month then Part D coverage would be 25%. My understanding is that catastrophic coverage will change to 0% in 2024 so there is hope for some relief.
VERY VERY critical here. Right now these drugs are NOT COVERED by Part D. What we need to explore is if this is ALL drugs or....covered Part D drugs. I truly am NOT sure the specialty drugs we take are covered under this since they are NOT part of Part D. Speak with a Medicare professional agent, but please be wary. They are OUTSIDE of D now. I think they are thinking about insulin far more than us women with MBC. And I do not see the drug companies coming down on price until they would need to be generic. I own my own company and the insurance for my husband and me, and he has nothing going on, is $32k plus. INSANITY....but when I think of drug costs. Look at how much the Faslodex shots are sometime...also insane!!!
hmmmm. oh I believe you! and yes prices are crazy. but I am confused. I have a part D coverage plan.....Humana....and it is billed thru my medicare.....approx $37/month. but of course I have to have medicare in the first place. I have been on it for 3 years now....and I am now at the point in the year where my meds are very cheap. now I have never taken ibrance or Verzenio but I have looked them up and they are covered by Humana. although the prices are insane. I want to say $6000/month?? but I really should go into the website and check for sure. I could be way off. but my point is that I think some of these meds are covered. a lot of women with mbc are on medicare?
I hope I didn't confuse even more. I probably did. I will check this out again and post tomorrow. XO
EXACTLY on the prices....they are not typical Part D drugs...they are SPECIALTY...like you cannot get them at your local pharmacy. Those companies spent millions to create drugs to keep us alive...and they want to be paid back. I talked to an agent at one point and he said...Ibrance is $12k a year; first month $3k then the rest monthly.....and Medicare plus a medical plan for my husband and me is like $12k a year, so $24K....BUT the $12K is out of pocket and to cover, we need to make X to pay for it. Hope not confusing, but it is all insane.
I guess Beth just answered it in her post. the speciality meds are covered under part D but the copay is ridiculous. good thing I declined ibrance as I am on disability and divorced and can not come close to paying those prices.
Hi CO- I too stayed on my expensive private insurance d just to get my drugs covered. I was put on Medicare after 2 years of MBC which should be good IF I could stop paying the high premiums, deductibles and co pays of the insurance. But since all drug plans with Medicare seem to call for 20% co pays for drugs… and with Verzenio costing $15k month, it is cheaper for my husband and I to keep paying $2k for our insurance than worrying about paying more than thst each month for all my costly drigs( also xgeva, lupron exemestane and the Verzenio
I'm 57 & living only on my SSDI. I was getting LD pay from work, but they say I've exhausted that. None of my Drs. believe it would be good for me to return to work & I have to agree. All they'll do is put me back on night shift & I couldn't take that anymore. I ran into the same deal & went with the manufacturer no copay offer with Pfizer. I don't think you'll get a better break. Good luck!
P.S. I'm on Humana Medicare Advantage & so far it's working better than employer coverage. I dropped employer coverage cause I need artificial joint revision surgery & Blue Cross / Blue Shield of Arkansas wouldn't cover the Dr. I need to do it., but he accepts Medicare.
Content on HealthUnlocked does not replace the relationship between you and doctors or other healthcare professionals nor the advice you receive from them.
Never delay seeking advice or dialling emergency services because of something that you have read on HealthUnlocked.
Verzenio 150 mg
New to MBC and SHARE
MBC Baggage
A year into MBC to Bones
Drug induced diabetes 
