Medicare

[Puppy_love]

I finally can retire in June this year and after diligent research with a part D plan I was very disappointed to see that Ibrance has a 600 copay a month. How can this be possible?? I’m told by others and read it’s 100 percent covered but now I’m told not true. Does anyone know is this is true and what to do now? Thanks all

[SeattleMom]

Check with your oncologist. He/she can provide the paperwork necessary to participate in the Pfizer Patient Assistance Program. No cost to patient at all. You can also call Pfizer directly to get the details of the program and a link to the paperwork: 877-744-5675.

Good luck! God bless you! Linda

[Puppy_love in reply to SeattleMom]

thank you for this information. I actually called Pfizer and they were very helpful and gave me some numbers to call.

[SeattleMom in reply to Puppy_love]

So glad you have already started the process. Ibrance is considered the Holy Grail as a line of treatment for MBC patients. I hope you get a lot of time on it!! Linda

[Southside25 in reply to SeattleMom]

Another option is to see if grant money is available, Your specialty pharmacist may be able to apply for you. My pharmacy, at a large Chicago medical center, has taken care of everything, be it grant money or manufacturer assistance. I've never lifted a finger in 5 years of treatment.

[Puppy_love]

Yes it’s actually working well I just have a lot of lung scarring which their not sure what it’s from. So if it’s the Ibrance I’m on to Piqray. I’ve been with Ibrance maybe around 3 yo 4 years give or take. And how are you feeling?

[Sharon0122]

My co pay on Medicare was 2900 a month. I told my doctor I could not afford that. Talk to your dr as you may be eligible to get it through the Pizter patient assistance. I did and I get mine for free. I also get my eliquis for free. Best to you. Hugs!

[George5545]

I’ve had success getting funding thru Patient Advocate Foundation and HealthWell Foundation for my mom.

[Puppy_love in reply to George5545]

Thank you so much for your reply. I surely need the help.

[AvidBooklover]

Thanks for noting this. It is one reason that at 66 that I stay on private insurance. Biden talked a max for Medicare in the State of the Union, but clearly did not know about specialty drugs not being covered.

[Puppy_love in reply to AvidBooklover]

it’s very disappointed where so many people need tier 5 medications. Private insurance must be so expensive.

[AvidBooklover in reply to Puppy_love]

$32k a year....I own my own company.

[fancydog]

thepatientstory.com/medical...

Hopefully this link will work for you. Abigail Shroeder Johnston was an attorney before being diagnosed MBC, she works to help people navigate health care and has gotten other attorneys to do pro bono work for MBC patients.

[fancydog]

Yes, about the Biden proposed cost reduction act does NOT include oral prescription cancer treatments. Its only going to apply to chemo or treatments administered at a Dr office or infusion center!!! growl!

[Nocillo in reply to fancydog]

SO ridiculous!!! So many things are out of office now. They need to keep up!!

[BluHydrangea]

on Medicare the government currently cannot negotiate drug prices the way insurance companies regularly do. So we are stuck with significant copays.

One of the bills passed by Congress last fall will make it possible for Medicare to negotiate drug prices and the 35 dollar insulin is part of that. Government has begun negotiations with Pharma and in Jan 2024 and finally 2025 we will have a cap of 2000 dollars per year for drugs. They are phasing some drugs in slowly.

If have financial need I believe Drug CO’s will provide assistance.

[Best521]

I am moving onto Medicare next year and have been paying close attention to drug coverage. While Medicare will begin negotiating drug prices using a phased in approach, I haven’t seen anything stating Tier 5 drugs are excluded from the Affordable Care Act cap which goes into effect in 2025. However I am hoping the Medicare SHINE representative will have the answer. Here is some additional information and a review of the Affordable Care Act from the health policy research group kff.org.

“Caps Medicare beneficiaries’ out-of-pocket spending under the Medicare Part D benefit, first by eliminating coinsurance above the catastrophic threshold in 2024 and then by adding a $2,000 cap on spending in 2025. Capping out-of-pocket drug spending under Medicare Part D will be especially helpful for beneficiaries who take high-priced drugs for conditions such as cancer or multiple sclerosis.”

kff also put together a great chart showing how it will work.

kff.org/wp-content/uploads/...

Until the Affordable Care act is in place, sadly for people on high cost drugs the existing rules apply. The Oncologist office will provide help when looking for financial assistance. The large cancer centers have representatives who can help direct you to organizations and the drug company programs.

[ClarenceO]

As everyone here mentioned, apply for assistance to Pfizer. I did, and they were terrific and gave it to me for free.

Medicare part D in my ZIP Code did not cover much of the cost. In retrospect, I wished I had stayed on my private insurance versus Medicare specifically because of part D. The Pharma lobbyists are strong. It would be nice if the 2025 drug cost caps were in place now. It’s very stressful to worry about pursuing assistance for drug costs, waiting for answers, working all the angles, etc.

I have a brand new unopened shipment of 75 mg Ibrance that Pfizer cannot take back. If you or anyone else needs it, I’d be happy to ship it to you. It seems such a waste to dispose of $10,000 worth of drugs. I was switched to Piqray the week Pfizer sent the Ibrance.

Suzanne

[Puppy_love in reply to ClarenceO]

I could use the Ibrance because I’m on 75 mg. How are you doing on Piqray? That would be my next medication if Ibrance stops working. Thanks I can give you my address if you want to send.

Write me at [e-mail] and I’ll give you my address. Thanks 😊