Can anyone help who was been through this with insurance?

[Eliactida1955]

I’m getting ready for Medicare -I’m here in Texas and have to let this Obama care go. Does anyone know a good plan to have for coverage ? An advantage plan -I know people are saying a supplement plan G is good then a plan for drugs. I’m worried about the Ibrance being covered . I was told there was no guarantee. If this is the case how is anyone being able to take it? Pfizer gave me credit and my insurance paid the rest. Pfizer will not Continue if you are on Medicare. Anyone can tell me how they are doing here in Texas ?

[Hidden]

Hi Eliactida1955 -

I keep looking at your question, wishing I had an answer for you! I'm also in TX, but not yet on Medicare. But I know I've seen some great, thorough answers to questions similar to yours on this site....and most of the info isn't specific to any particular state, e.g. starting with the financial folks at the doctor's office, seeking grants, etc. It's just horrible that in this day and age people have to scramble, zig and zag, to piece together funding for these meds....

So maybe try using the search bar, upper right, to find some of the previous posts/responses?

I'll mention that, a few years back, I was deciding whether to go on Medicare or remain on private insurance. I called AARP's representatives from their insurance partners and got detailed information about the cost of coverage and amounts covered for Ibrance in Texas and in one other state in which I could easily claim residency. Texas, of course, was worse.

I'm confused/concerned re: what you're hearing about Ibrance not necessarily being covered....Is it possible that they were just saying, in general, that they can't assure any given individual that the claim will be approved...e.g. they need a doctor's notes to approve it? I've never heard of someone being declined for this drug but, as you know, the question is how much will it cost...

I wish you luck with it...quite a process and pain in the neck...and I'd be grateful if you can share what you learn, especially since at some point I will have to go on Medicare...

Best,

Lynn

[Eliactida1955 in reply to Hidden]

Thanks Lynnfish I cannot keep the private insurance as it’s medicare time. I’m checking now on the plans and no one wants to cover Ibrance -so expensive . Thanks for your response. I might have to look into funding -🙏❤️

[AuntyJane]

I started Ibrance+Faslodex last summer and just retired, Under my employer private group insurance (Cigna) everything was covered 100%. Now I am on straight Medicare A+B so I can see any doctor who accepts Medicare. With Medicare Advantage plans it’s like an HMO and you have to stay in network/get referrals/approvals so I didn’t go this route although it’s much less expensive.

I bought supplement Plan F (similar to G except it includes Part B annual copay) to cover the 20% Medicare doesn’t cover along with Plan D for drug. My oncologist office said my co pay for Ibrance will now be $2783 month! They are looking into finding a grant to help me with Ibrance co pay expense.

Supposed since Faslodex is an injection at the doctor office, it’s covered under Medicare Part B. I get my shot next week -the first time since I’ve been under Medicare so we’ll see. It is mind boggling all of this now and heard lots of paperwork, billing/coding errors, etc often occur. So I’m trying to keep detailed records from the start.

I suggest finding a insurance agent who can help you navigate through all the options. I’m in Calif and mine can only help residents in state. Good luck!

[Eliactida1955 in reply to AuntyJane]

It’s tough-thanks for responding.🙏❤️

[Selmac in reply to AuntyJane]

Aunty Jane, I do know Faslodex will be under your medical medicare and not your prescription coverage. Been there with that.

[AuntyJane in reply to Selmac]

Thanks for the reassurance...great to hear!

[Staysha]

I’m not sure where I read this but Pfizer offers help if you have private insurance. There is a law where they can’t help if you have Medicare because it can be considered as a government kick back. It’s ridiculous to have to pay 3000 per month for this drug. We have enough to stress about.

Wishing you the best in figuring it all out.

Stacy

[Eliactida1955 in reply to Staysha]

Pfizer is great and yes my medicine has been covered with not anything out of pocket for a year and a half now. Thank God but now with Medicare they won’t help . It’s a hard road but maybe I will find a grant because there isn’t any company that’s wants to cover the cost of the med. I’m hanging in there. Thanks🙏❤️

[Selmac in reply to Staysha]

Staysha, I do know with private insurance Pfizer covers copays. With medicare they call it coinsurance instead of copays. Mist private insurance copays are the same small amounts. Medicare puts every prescription on a tier. The higher the tier, the higher your percentage is to pay for that medicine. Cancer drugs are sometimes not on any tier and cost is usually 35% of the drug. If you cannot afford that high cost is when Pfizer and Novartis sends the drugs to you free. It's all complicated but I've been through it all with it. Not trying to be a know it all, I've just had a lot of experience.

[Staysha in reply to Selmac]

Thank you Selmac. I don’t think that at all. That’s one of the things so amazing about this group...Learning from the experiences of others similar to you. Of course the other thing is the support and caring of all ‘y’all’. (From Georgia).

Btw. Happy Mother’s Day.

🙂Stacy

[Buffwright]

You can check to see whether Ibrance is on the formulary. It usually is. I have Plan F (which may not be available anymore) with Anthem Blue Shield and a drug policy ( in California) It provides more than an advantage plan, which is like an HMO. An advantage plan is great if you like the providers and don’t plan to move. My plans cover much of the cost of Ibrance, but it’s fairly typical to pay at least 5% (over $600) a month. I didn’t find one that was better for my situation. I’m on Afinitor now and that started at $890/mo!

If you are qualified for assistance, pursue it!

Interesting that the affordable care act insurance is often better than Medicare supplement options...

Good luck!

[Eliactida1955 in reply to Buffwright]

Thanks so much -I’m looking into it now.🙏❤️

[Selmac in reply to Buffwright]

Buffwright, I do have a question if you dont mind. When my husband retired he lost his private insurance and wasnt 65 yet so couldn't get medicare. His quote was 1500.00 per month for Affordable care Act with a 10,000 deductible. How can that be cheaper than medicare?

[Eliactida1955 in reply to Selmac]

I had Obama’s Care and my monthly payment this year was 266 last year it was 118$ monthly. Once I met yearly out of Ocker which was the first month -I paid no co pays. The insurance paid their part of the Ibrance and I aid nothing out of pocket for any other meds or treatment s. However if there is not enough medical at the end when taxes are due then you pay thousands-down here inTexas the cap income to qualify was around 66,000 a month. We barely made it but really this was the cheapwast unless you are low income. I think Texas is one of the worse states. What can we do except move and we are thinking about it. Overseas meds are free at least Ibrance is. 🙏🌷

[Selmac]

I'm on medicare and have a supplemental. I also have a prescription plan that medicare has to approve. I was in Ohio and moved to South Carolina and nothing changed. Last year Novartis and Pfizer both sent my medication absolutely free. Pfizer is sending it free this year as well. My Oncologists pharmacist found a patient assistance program for me where they pay the entire amount that my insurance doesn't pay for my Afinitor. It worked well as I was in and out of the donut hole in one month. Now all my other prescriptions are really cheap. As far as the advantage having a prescription plan built in and costs much less it's a farce, my opinion. In oh where I lived I could have only gone to one Oncologist, one hospital and one primary care physician whether I liked them or not. If we traveled two hours to visit my brother in law and had to see a dr or go to the hospital, it wouldn't be covered. Yes, you can get help on Medicare, I'm proof of that and we are retired and dont do bad financially. Your Oncologist should have someone in his office that helps. All I'll say is we make over 80,000 per year and I received help. They did ask for household expenses. If I can help any other way in answering any questions, feel free to ask.

[Eliactida1955 in reply to Selmac]

Thanks for your advice. I have received Ibrance free with their program but now it will stop because of Medicare. I will look into it all. 🙏❤️

[Remyan]

I am not in Texas but I am on Medicare and the Pfizer Patient Assistance does cover the cost of Ibrance. So please do not despair but call Pfizer on Monday regarding how to apply for that program. My cancer center helped to do the application. Perhaps if your doctor is at a center there is someone that can do that for you.

[Eliactida1955 in reply to Remyan]

I am receiving it free on Obama’s Care but now it’s clear with Medicare they will not continue. Pfizer has been great. I am looking into programs. Thanks for your response. 🙏❤️

[SeattleMom]

Hello!

I’m on Medicare and my Ibrance is fully covered by Pfizer. Just fill out an application (can download on Pfizer’s website), which also includes questionnaire for your oncologist. In addition, my oncologist advocated for me with direct phone call to Pfizer. DON’T GIVE UP! IT CAN BE DONE!

God bless you! 🙏🏻💗🙏🏻💗

Linda

[Eliactida1955 in reply to SeattleMom]

Linda-are you on medicare?

[JBirdnut]

Hello Eliactida.

My Humana advantage plan's copay for Ibrance was through the roof. I was very distraught and was speaking with the cancer center's nutritionist. She gave me the phone number to call for grant assistance. I called and got a grant with zero copay. Lifted a boulder off my shoulders!

I found out later that there are two employees in my oncologist's office that could have helped me...but no one told me to get financial help there.

After Ibrance quit working, I was back to the infusion suite and receiving Eribulin. The grant followed me there till the end of the year.

I reached out to the same people who got me the grant and I had another grant which started in January.

After that treatment quit working, I went on Afinitor and grant covered that huge copay.

I am still getting help from a grant from The Assistance Fund. The original grant was from The Patient Assistance Network (PAN).

Best wishes,

Birdnut in Louisiana

[Eliactida1955 in reply to JBirdnut]

Thanks so much for your response. How long were you on Ibrance when it quit working? I’ll check into that info has been helpful. Hang in there as I’m trying to.🙏❤️

[JBirdnut in reply to Eliactida1955]

I was on Ibrance for 5 months when it stopped working.

it did kill the liver tumor, but none mets spread.

Best to you.

Birdnut in Louisiana

[Eliactida1955 in reply to JBirdnut]

I had three tumors in my left breast and one small one on the right. It had spread to my spine and right femor . After 6 months of being on the med Ibrance and letrozole it was gone. My tumors they said were like scar tissue from radiation and right tumor in the breast disappeared. The right femor lesion is gone and nothing is lightening in my body-it’s stable they say about my spine. I am so grateful for everything and I hope the best for you-I was diagnosed sept 2018 . Thanks for your response. Keep living life!!🙏❤️

[JBirdnut in reply to Eliactida1955]

All good news! What about your spine tumors. So you are continuing on Ibrance?

[Eliactida1955 in reply to JBirdnut]

Yes I will continue on it if I can afford it-.The spine is stable-nothing lighting up anymore and nothing has spread . My left axilla lymph node 6 months ago lit up in the pet scan and it was the only thing. Now they told me it was calcified. I pray to my saints and God every night. Just last year went to Jerusalem to be baptized again and a old monk told me to pray to the saint for my cancer. He saw me at the monestary and knew I had cancer. Put his hand on my head and prayed. Wishing the best for you— 🙏🌹

[JBirdnut in reply to Eliactida1955]

It sounds like Ibrance is really working for you.

Definitely do some research about getting a grant. They are hard to come by as the months go by.

Best to you.

[hdhonda]

I am so sorry. I am on Medicare part A and B. I am not on Medicare part D. I kept my insurance from my former employer with the drug benefit. It is expensive, but is now the supplement to my Medicare. I don't know what is going to happen to insurance if Obama Care is dismantled. I sincerely hope they come up with a good replacement.

I believe Part D is considered a federal drug program. I wish you and all of our country the very best. Blessings Hannah

[Eliactida1955 in reply to hdhonda]

It’s terrible that we don’t have better insurance-hopefully something will work for me. Thanks for your response.🙏❤️

[hdhonda in reply to Eliactida1955]

Prayerfully hoping that a good solution is available. Blessings, Hannah

[Jaxon2007]

My Mom had Medicare and Plan G and never had to pay a penny after the $184 or whatever deductible but she wasn't on any medications. Just Chemo.....I suggest you look at each plan offered in your area or contact your pharmacist and ask which one would pay for the Ibrance. Also you must consider that eventually your medication might change to another drug.

[Eliactida1955 in reply to Jaxon2007]

Jaxon I never thought of that -hopefully the pharmacist will say. I’m thinking of a supplement G and a drug plan . Thanks for your response. 🙏❤️

[PJBinMI]

I am not in Texas but I have always heard positive things about the United Health Care plan thru AARP. That is something to find out about if you are over 50 and can join AARP (I should have said 50 or older....) My mother didn't have much money after she retired and when she got cancer, her plan thru AARP was a real money saver for her. But that was 35 years ago! But knowing how much it helped her, I've paid atttention to what others report about that Medicare Supplement.

[Eliactida1955 in reply to PJBinMI]

My husband has this plan and it will work for him because he doesn’t go to the dr much and not on any meds. There is an attna advantage plan I’m looking at but leaning towards a sup G plan with part d. It’s a mess. Work all our lives get sick and then the insurance you can’t afford. Thank you for your response. 🙏❤️

[viennagirl]

Hell Eliactida1955.

It makes me heartsick to think that you are struggling with being able to pay for your Ibrance cancer medication. In my country cancer drugs are free to anyone who needs them. You just need a doctor's prescription. I think you should pressure your government to do the same. No one should have to go begging for medication when they are ill. And I don't think anyone should be profitting from illness. I wish you the best of luck in your search. In the meantime, you might be able to find information on-line that will keep your immune system safe until you can get your meds. There is so much wonderful information on You Tube and I think a time will come when we will learn more about how to heal ourselves. Although we should not follow the on-line health information blindly, we can learn more about our illness on line and learn more about how to take care of ourselves when we become ill. I wish you the best of luck in your search for a company who will cover your drugs. Hugs Marlene

[Eliactida1955]

Marlene my husband is from Greece and the meds are free there too. Our country and big Pharma is too wrapped up in the $$ and people die or go without food just to pay for their meds. This country is awful and honestly we are thinking about moving overseas because of this. People think the U S is the best -well it’s not. Now more than ever with this crisis I see what they haven’t done for the citizens. Hopefully I’ll find a solution to all of this. Thanks for your response. 🙏❤️

[LadyPastor]

Well, I am not in Texas. I am in Arizona. But I can tell you what I know. Surprisingly my Medicaid insurance pays for my Ibrance even though it is at the cost of 21 pills for 15,000. My Medicaid is through United Healthcare and I know they do also cover Medicare.

[Eliactida1955 in reply to LadyPastor]

Thanks for your response. I am not on Medicaid but Medicare so I don’t qualify.🌹❤️

[Klamato]

I found that the supplement with Medicare is AARP! It is more expensive, but I never get a bill for anything since I got on this plan. Look into it!