29 replies to this topic

[tiredblood]

I'm several years from being on Medicare, but I was curious as to what copays are like when you get 65 and are on Medicare or Part D plans.

[gootzeitb]

I was wondering the same thing. If you go to. Social Security web site,, check the premium and benefit calculator and then check out the drug plans..

It wasn't very comforting but it seems to vary by the drug plan u select

Would love to hear any moe info on the topic too!!!!

[VickiW]

Only thing i know is there is a huge (translate $$$$) donut hole and not all TKI's are even covered.

[lanadal]

I live in Washington State and have a Medicare Advantage Plan with Kaiser Permanente.  I get my Gleevec with no copay!!!   My Kaiser plan also has no doughnut hole.  I was very reluctant to join Kaiser as I had been gotten terrific care at OHSU.  I did have to research Oncologists and have changed Oncologists once, but I was able to find someone who knows about CML and Kaiser makes it easy to change doctors. When I compared any plans that would have allowed me to stay at OHSU they were prohibitive.  Many required that I pay 40% of regular medical test costs and PCR tests aren't cheap. They all included the doughnut hole and copays for Gleevec started at @ $40. 

[gootzeitb]

Right now I'm on Obama care to get Gleevec in maryland , most of the plans charge approx 30% of the drug cost

So I joined the platinumum plan thru care first , the premium is 800. Month but co pay is 200
Something wrong with this picture ??

Def going to check out Kaiser !

[Vietnam67]

I am on Medicare but I am also a 100% disabled veteran so VA picks up the tab but I must also have Medicare and Medicare part B just in case a VA hospital is not available.  My VA is terrific and they take very good care of me.

[SUE]

I have AARP Part D.  My initial 1 month copay for Sprycel is more than $1800.  For the 2nd payment I straddle the doughnut hole and catastrophic, and my payment is usually about $450.  After that I am completely in catastrophic, and my monthly payment is about $250.00.

 

Each time I go to the pharmacy to pick up the prescription, they ask me if I know how much it is.  I guess they don't want anyone collapsing from shock on the pharmacy floor.  

 

I think that the price of the medication is disgraceful.  Sadly, I don't see it changing anytime soon.

 

Sue

[tiredblood]

I learned about oral parity laws at the CML summit.  Well, I learned what they are.  Sounds like this would help those who take TKIs and are on Medicare.  From what I understand, the law is aimed at considering or likening oral chemotherapy to other non-oral forms of chemotherapy and billing them the same way.

[tiredblood]

Wow, that is catastrophic!  I guess I've reached some milestone or out-of-pocket maximum on my insurance, because I've had a couple of copays from the doctor that were refunded.

[tiredblood]

Thank you for your service, Vietnam67.  When I was a child, I remember standing in front of the black and white TV hearing the newscasts on the coverage of the Vietnam war.  It is only by the service of others who serve our great country, that I was able to live safely in a loving nurturing home.  I'm glad you have a terrific VA in your area.  I work at the VA in our area and I think it is pretty terrific too.  If anyone ever asked me, I'd say, "Just ask our patients."  I enjoy our patients so much.

[chriskuo]

The oral parity laws have been passed by at least 20 states.  There is no similar Federal law currently that applies to Medicare.

 

The very high copays that occur in the Medicare Part D donut hole will be affected by the gradual shrinkage of the donut hole until it is eliminated in 2020.  The copay in the catatrophic phase which follows the donut hole is limited to 5%, which is can be substantial, but is more reasonable.

[sunshineC]

Hello everyone.  I too am quite a ways off from retiring.  I work for the federal government and carry Blue Cross/Blue Shield FEP (Federal Employees Program).  I am fairly new to all of this.  I was diagnosed and put on 100mg Sprycel in early March.  My first month of Sprycel was free from the drug company.  If I understand it correctly, my insurance and the drug company have some sort of agreement for the first year, so I have a $35/mo co-pay.  I am so afraid of what might happen next year I haven't even looked into it yet, but I am running out of time.  Has anyone else heard of this 'agreement' and know what happens after it runs out or what I could be facing?  Also, could someone explain what this 'doughnut hole' is that I keep hearing about?  I have no clue.  Have any of the TKIs we take gone generic yet?  That would make a difference, right?  Sooooo clueless. 

[hannibellemo]

I don't understand why the way medicare works is such a big, damn secret!  Isn't there anyone on here who is on medicare? Probably not, because we all need to work to keep insurance to afford our drugs!

 

Pat

[chriskuo]

I'm on Medicare with a supplement through my retiree health plan.  The employer subsidies benefit mostly my wife who is not on Medicare.  They also cover the Medicare Part D donut hole, which is important for TKI users.  However, on Sprycel, you are through the donut hole and into catastrophic coverage by the third month of the year.  My Part D drug plan follows the maximum copay of 5% in catastrophic coverage, so my copay for Sprycel for months 3-12 is $261/month.

 

The donut hole is the phase is Medicare Part D coverage where you are responsible for most of your drug costs.  The donut hole is currently several thousand dollar and under ACA, is shrinking every year until it goes away entirely in 2020.  You will be affected by the donut hole if you have Medicare Part D drug coverage from the time you turn 65 until 2020.

[sunshineC]

Thanks chriskuo for the doughnut hole explanation.  I will be 63 in 2020 so i guess we'll see what they come up with by then.

[Marnie]

Hi, Sunshine.  I'm on FEP Blue also.  The copay will depend upon the plan.  It is important to read through the benefit packages carefully so that you make a smart choice.  I'm not sure if your employer has a choice of Basic Plan and Standard Plan, but my guess is that they do.  For me, one plan has a percentage for drug coverage.  The other has a dollar amount.  Obviously, I chose the one with a fixed dollar copay.  A percentage of the cost of Sprycel would be pretty awful.

 

I don't think you have much to worry about on FEP Blue.  It's huge, so I think it will always have reasonable benefits.  However. . .you will need to read through both plans very carefully each year to be sure you choose the best option.  I would also recommend that you read and understand all of the benefits yourself.  Don't count on doc offices/hospitals to always do things right.  I ended up getting a couple of refunds from the hospital because they charged me incorrectly.  I try to anticipate what the cost will be before I go in for anything.  I've been dealing with multiple visits to the hospital lately for x-rays, thoracenteses (thoracentesises??), lung function tests, etc.  I know my benefit package better than most computer systems at the hospital, and I know it a LOT better than the people who work at those computers.

 

Each year, read both benefit plans, look carefully at the prescription drug part, and then make your choice.

 

Marnie

[sunshineC]

Thank you so much Marnie.  I do feel a little better now.  Yes, I'm afraid I will be doing a lot of reading and comparing from now on.  I can't even remember which plan I'm on now for sure.  And I am one of those that never questions.  I must have done something right tho - I have the Family Plan and with everyone having a rough year, my husband and I haven't paid for any prescriptions at the pharmacy for a month or more now.  Something about reaching the limit.  THAT was a nice surprise, let me tell ya!!  I hate trying to figure out all this stuff.  I can read - it's the translation and comparing that drives me crazy!!  Hey Marnie, sounds like you're an expert - how bout I just hire you to figure all this stuff out?!?!

[gianfranko]

Right now I'm on Obama care to get Gleevec in maryland , most of the plans charge approx 30% of the drug cost

So I joined the platinumum plan thru care first , the premium is 800. Month but co pay is 200
Something wrong with this picture ??

Def going to check out Kaiser !

 

For all persons on gleevec who have co-pays higher than $100:

 

Novartis has a gleevec copay assistance program that would drop the costs to $100.  It's worth a shot calling them up and asking if you qualify.  My wife's copay was $250 for gleevec and the program dropped it to $100.  It's far from a $0 copay, but every dollar helps!

 

The Novartis program can be found here:

 

http://www.patientas...376934468416817

 

 

 

To those taking Sprycel:

 

Other assistance programs can be found here:

 

http://www.nationalc...stance-programs

 

The second link on that page talks about a program for Sprycel; more info:

 

Access Support™, the Bristol-Myers Squibb Oncology reimbursement services program, offers patient assistance support, benefits investigation, prior authorization support and appeals assistance. Program counselors are available Monday through Friday, from 8:00 A.M. to 8:00 P.M. ET at 1-800-861-0048

[Marnie]

BMS used to have a Sprycel CoPay card, but they dropped the program awhile back, I think.  It was a nice program while it lasted. 

 

Sunshine. . .I didn't used to be an expert.  But after 5 years of dealing with this, I've certainly learned a lot.  Never thought about this stuff before cml, and didn't realize how much there was to learn about the health insurance system.  After quite a few phone calls and phone tag games that went on for months, I've learned to be a bit of a bulldog.

 

As to your proposal.  Hmmm. . .if you make me a good enough offer, I'll quit this job in a heartbeat!  Teaching definitely has its moments!

[sunshineC]

That's interesting Marnie - I am such a little mouse about standing up for myself (usually).  It takes a lot to get me in a fighting mode.  My daughter, however, is completely opposite.  After spending a little time with my daughter, my husband (obviously not her dad) nick-named her the 'Bulldog'.  I respect and give you both many kudos!!!! 

And I'd love to be able to hire you... but I get the feeling if you have FEP Blue, there's no way I could afford you!!!

 

BTW, Am I allowed to ask personal questions???  Oh well, if not, slap my hands and put me to bed... Here goes:  I see your pic - is that you on a motorcycle?  I think I read on another topic that you ride dirt bikes??  Can't remember for sure - somethin about riding B.....???  Anyway, my husband and I have a Harley and that's the ONLY way I ride.  Much better I think.  I just sit back there, chillin, lookin around... love it!  And, my husband sells Harleys!  We live on border of PA & MD.  Let me know if you're close and/or ever need a Harley! - I got connections!!!  I can hook you up girl!!!!