14 replies to this topic

[Happycat]

Hi,

I was just sending in some FSA claims and when I went to snap pics and make jpegs of my Gleevec receipts to upload, I realized it actually says the copay is "$0 Adj".  It has apparently been like that since January, and I never noticed.  (They normally mail the Gleevec to me and just charge my credit card automatically.  I never hand over anything to pay.)  Has anyone else seen this?  I have Blue Cross in MA.

Traci

[Trey]

I believe this is why, and changes are apparently catching up on some drugs:

http://blog.dana-far...why-it-matters/

[RayT]

Trey is right on the money!  I was just diagnosed with CML 3 months ago.  I have Blue Cross in NY and my hem/onc explained that BC considers Gleevec a chemo Tx (not an Rx med) so I save a $40/mo co-pay.

[may04CLL]

hoping this will be approved for all cancers and all states past this law . CLL patient here.

[chriskuo]

and for Medicare as well

[Happycat]

Well, dang, I live here, you'd think I'd have heard about that!  Maybe I do have some dim memory about it in the news, but I probably wasn't sure what it would mean for me. Now I know.

Thanks, Super Sleuth.

Traci

[Buzzm1]

My Gleevec Medicare co-pay is $10 .. no complaints here .. the complaint I do have is that Kaiser won't mail the Rx and I have to pick it up every month... hoping that will change when/if it goes generic.

[SUE]

Buzzm1,

My Medicare monthly co-pay for Sprycel started at close to $2000 this year.  I go in and out of the "doughnut hole" really fast.  And even when I go into the Catastrophic phase, my co-pay is more than $200.  Last year, when I had Gleevec, the cost was even higher.

What kind of prescription drug plan do you have?

Sue

[Buzzm1]

Sue,

Your co-pay sounds painful ... if at all possible hoping that somehow it will improve for you ...

It's a Medicare Advantage plan through my former employer, Lockheed Martin, negotiated with Kaiser, which has a drug plan wrapped in... I pay an additional $112/mo. for it, deducted from my pension, above the Medicare $104.90/mo., deducted from Social Security.  It doesn't have a donut hole, but for whatever reason, my co-pay does drop from $20.to $10 after January/February.

Buzz

[SUE]

Buzz,

I have a Medicare Supplement plan, and a separate Part D plan.  I don't know what the co-pay is for Medicare Advantage plans in general.  Maybe yours is different from most because it was arranged through your former employer.

I did read somewhere that even in states which require oral cancer drugs to be priced similarly to injected drugs, Medicare is excluded from that requirement.  I don't know why that would be the case.  It doesn't seem right at all.

Have others found that Medicare prices for the TKI's are becoming more reasonable?

Sue

[Buzzm1]

Sue,

maybe take a look around for Medicare Advantage plans, or some other form of Medicare Supplemental plan, just so you know ...   I don't know what the differences are, but I do know there are a lot of plans.. From what you said you have a >$4200/yr. out-of-pocket expense for Sprycel; that's $350/month above whatever you are paying for your Medicare Supplemental, plus the $30?/month Medicare Part D.  Wouldn't hurt to shop around .. you never know  .. maybe someone else here has some insight ... come to think of it ... my former employer does pay for a chunk of mine ..can't remember the details ...

in regard to Medicare Rx drug cost. . thanks to Bush/Obama agreements with Big PhRMA, Medicare patients are charged the highest prices in the world for Rx drugs (paid for by taxpayers) ... no it isn't fair ... with less than 5% of the world's population, we consume about 70% of the world's Rx drugs ... Medicare Rx drugs, is a large share of the market, and are huge profit makers.  We would think both parties would want to change it? .lol.. no, Big PhRMA is the largest lobbyist in Washington DC. .. the re-election campaign money is too good to pass up

Buzz

[SUE]

Buzz,

I might take a look at some Medicare Advantage Plans.  But I am really happy with my Part B supplemental. 

Maybe with all the "Baby Boomers" joining Medicare, the politicians will be moved to correct the situation.  I sure hope so.

Sue

[chriskuo]

The problem is that reducing the copay on cancer pills in Medicare Part D catastrophic coverage will mostly come out of the Federal government's pocket.

Medicare Part D allows 5% copays in catastrophic phase and Medicare is not allowed to negotiate drug prices with drug companies like commercial insurance companies can.  Many companies subsidize their retirees copays in the donut hole.  It is less common for companies to subsidize the 5% copay in the catastrophic phase.

The states which regulate commercial plans can force insurance companies to limit copays without having to reimburse the insurance companies, although they review the premiums that the commercial insurers can charge.

[MACELPatient]

Yup.  Copay is now $0 and has been that way for quite a few months too.  I also received a refund check from my prior insurer for about 10m worth of pills.  Was a pleasant surprise and one where Mass is ahead of the curve on this.

[winespritzer]

Hi Sue,

My Sprycell co-pay is $480.  I am dreaming of any reduction. I live in NJ and have Xpress Scripts. Wonder if I move to MA where we have a little home if I could get the parity.

I hope this $480 co-pay is worth the 3 month test result I just received:

b2a2 transcript- <0.001%

b3a2 transcript- <0.386%

e1a2 transcript- <0.001%

My oncologist said it was a major molecular response.  I thought a MMR was <0.1%

I will be receiving  a 1 month co-pay from Bristol Meyers Squibb - like winning a lottery!

When I return to oncologist in July I am asking him to write my prescription up different to help me get reimbursement from Medicare.

Best is that my rising liver enzymes went back to normal - but not celebrating with a ton of wine!

Winespritzer

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