MBC Medicare Drug Plan

[ClarenceO]

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

[Southside25]

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.

[ClarenceO in reply to Southside25]

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.

[NShaft]

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.

[AvidBooklover]

I just read this:feeds.aarp.org/politics-soc...

I highly recommend talking to an insurance agent!

[OneLump22 in reply to AvidBooklover]

Outstanding! And it isn't too soon for a lot of us. I had no idea. Thanks for the post!

[kokopelli2017 in reply to AvidBooklover]

thanks for the article👍

[AvidBooklover in reply to kokopelli2017]

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!!!

[kokopelli2017 in reply to AvidBooklover]

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

[AvidBooklover in reply to kokopelli2017]

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.

[kokopelli2017 in reply to AvidBooklover]

such a mess. thanks for clarifying!

[kokopelli2017 in reply to AvidBooklover]

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.

[AvidBooklover in reply to kokopelli2017]

EXACTLY....covered by at what cost?

[WhippetX2 in reply to AvidBooklover]

Thanks for the article. Great info!

[Bettybuckets]

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

[ClarenceO in reply to Bettybuckets]

Thank you. Yes, when I did the math on the Part D copays and then 27% of drug cost under catastrophic, that's the same conclusion I reached.

[OneLump22]

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.