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TKI copays on medicare plans: Curious as to how much?


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#21 Marnie

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Posted 10 September 2014 - 08:17 PM

My true love is my beemer. . .f650gs.  I am a hack on the dirt bike, but it can be fun.  Unless it gets too hard, and then I cry.  My husband has learned to tone it down a bit.  He does not come out in a good place if I have a bad day on the dirt bike. 

 

Wish I could say that was me in the pic, but until I get around to figuring out how to get my own pics in the right format, I had to download one from google images.  The pic is, however, what my bike looks like.

 

I'm not the highly paid one in my family. . .my husband is the fed.  I'm a lowly school teacher who doesn't make nearly enough money.  My school insurance plan used to be good, but then they went to a stupid plan that had me paying $4000 out of pocket the first month, when I ordered my meds.  I had to go on to my husband's plan.  Pissed me off enough that I quit being on the teacher negotiations team, of which I had been a part for many years.  My colleagues on the team did not understand how the health care system worked.  I could not convince them. 

 

More bike info. . .when my husband first bought a bike, it was to be a shuttle vehicle for when we kayaked with just the two of us.  Safer than a hitchhike shuttle.  That seemed fun, so he moved up to a bigger bike.  I rode on the back of the bike once.  It became clear to both of us (immediately) that I needed my own bike.  I seem to be a control freak (and he says I'm a terrible passenger).  Bought my first bike 3 days later and had to ride it down I-25 (Interstate through Denver. . suicide. . .Coloradoans do NOT know how to drive!!!) 2 hours to get it home.  After that ride, it was true love.  Who knew I could become a motorhead?!  I did not grow up around bikes. 

 

We are SO looking forward to the day that we are both retired and can pack up the bikes and hit the road for months at a time.  We love camping off the bikes.  Have taken them on many trips, but have always been tied to work, which has been a frustration. 

 

Anyway, just an FYI that I used to be pretty timid about speaking up.  You learn, in this cml business, that often you know more than the docs.  My doc just left me a message that he wants me to go back on Sprycel (off now due to pleural effusion) on 20 mg twice daily.  I know that Sprycel is NOT to be taken twice a day, as that increases the risk for pleural effusion.  So I talked to his nurse and (hopefully politely) asked her to have him check on that. 

 

The more time you spend on this forum, the more you will learn, and the more you will realize that you probably know more than your doc does.  Cml is an "easy" disease now. . .unless there are complications.  The specialists know a lot, but most cmlers don't need a specialist.  Know your stuff, and don't be afraid to let your doc know that you know. 

 

I bring a list of questions to my doc appointments.  Even if my questions are stupid (and often they are), I ask them.  I think my onc respects the fact that I am pretty well informed.  Most patients probably are not. 

 

AND. .lastly. . .I do tend to jibe a little bit about Harley riders.  But I have great friends who ride Harleys, and anyone on a bike is a compatriot.  There's just nothing like smelling the trees as you ride through a pine forest.  You don't get that in a cage.  You guys need to come out to Colorado to ride.  There are no better roads in the nation!

 

Ride safe!

Marnie



#22 tiredblood

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Posted 12 September 2014 - 10:28 PM

I have fepblue too (Standard Option) and haven't heard of the agreement of which you speak.  I did learn recently that CVS Caremark specialty pharmacy will accept the patient copay assistance card from Novartis (Opus health) for Tasigna, unlike the regular 90-day mail order that won't accept copay assistance cards on other drugs.  This has helped me save $190 in copays for my last two fills for Tasigna this year.

I started this thread because I was thinking ahead as to if I were able to work past age 65, would I come out better keeping the federal health insurance benefits plus Medicare versus a D-plan and Medicare, dropping the federal health insurance.  The medication may be as cheap as dirt by then anyway.  And, if oral parity kicks in, the drug wouldn't fall under drug benefits or D-plan, but under medical benefits I believe.

 

I just read that chriskuo (sp?) says that oral parity wouldn't apply to Medicare coverage.  You know what else bites?  The fact that folks on Medicare can't use the copay assistance cards.  What's up with that?  I better go to bed before I hop up on my soap box.  Have a great weekend everyone.



#23 sunshineC

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Posted 16 September 2014 - 06:09 PM

Hey Marnie!  It was so nice to hear from you.  So sorry it's taken me so long to respond.  As you probably already know, Sept 30th is the end of our Fiscal Year, and suffice it to say, everything just goes nuts.  I hate it!  So, I haven't had the time I normally do to check out this site.  And, for some (still unknown) reason, I could not get on the internet at all over this past weekend.  Hopefully that'll get figured out.  Probably something stupid like the cats unplugging something. 

 

Anyway, I also had to change GP's.  I've been going to the same guy since 1994 when I moved to Maryland from Upstate NY.  He was a doll, but he decided to join this 'thing' where you have to pay $1600/yr just to have him as a doc.  And, you still have to pay regular co-pays as before.  I like him ... but not THAT much.  Besides, I'm over an hour away from him now since we moved.  I saw my new GP yesterday and she is wonderful.  I was so relieved to find how much she knew about CML.  And she's just around the corner!  Sometimes everything happens for a reason, right?

 

I am trying to be braver than I was.  I did tell my previous onc that he really needed to listen to his patients cause we're the ones that know ourselves the best.  When I complained to him about the really bad headaches I was having, with dizziness, and nausea, he said well, you had headaches before right?  And I swear, I didn't.  Not anything like this.  I would get maybe 2-3 headaches a year before.  But when I got them they were bad.  I felt so sorry for others who got headaches.  But it's like I had to talk him into believing that I was experiencing side effects.  (and one of his nurses was even worse!)  He minimized everything and just shrugged his shoulders when I did ask questions.  My daughter (the bulldog) didn't like him AT ALL from the very beginning but let me make my own decisions.  Well, I think being on this forum helped me learn a lot too.  Because of what his nurse (who had previously told me to call if I had any questions at all - she seemed so nice), and then actually had her YELL at me after being on Sprycel for about 3 months when I called concerned because of how tired I was all the time (I would sleep half the day away and all night), saying that my bloodwork was fine - there is no reason why I shouldn't be back to work by now - anyone who looked at my bloodwork wouldn't even know I was sick!!  Well, that was the last time I was going to call there with any questions or concerns.  And then having to fight him on what I KNOW is a side effect ... that's when I finally figured out it just wasn't worth it any more.  You're not suppose to be afraid to call your doctor's office or have to fight with him.  And then I started thinking what if, God forbid, I did end up with problems (as I had read on here).  I didn't want to deal with these people.  That's why I got a new onc.  I don't see him until Oct but I've been feeling better so I'm sure it'll be okay.  I'm still taking the Sprycel every day.  And i feel very hopeful about this guy.  He works out of Johns Hopkins and helped head a clinical trial for a vaccine for CML.  Let's hope he has a good bedside manner - as I obviously seem to be high maintenance!

 

With the hours my husband and I work, and our days off not matching much either, and of course being sick earlier, I've only been on the bike with him once this year.  But, it was one time more than last year!!  It was awful last year.  We just never could find time when both of us were home, weather was good, whatever.  I was so PO'd!  This year, that one time, oh man it was great!  I know EXACTLY what you mean about the smell of the pine forests!  Only problem I've had with that is when the farmers decide to fertilize their fields - that can really be nasty!  But, all in all, it is DEFINITELY worth it!!  I love going in the fall too when I can smell people's fireplaces burning!  Hopefully we will be able to get a few more rides in before it gets too cold.

 

Well, I gotta get outta here for now.  Hopefully we will be able to talk again.  I look forward to hearing from you.   



#24 Marnie

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Posted 16 September 2014 - 08:54 PM

Good luck with the year end.  I definitely know how that goes.  Long, long days at work.



#25 gootzeitb

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Posted 18 November 2014 - 05:22 PM

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 !



#26 SusanL

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Posted 18 November 2014 - 06:59 PM

I live in Ca and have been on Medicare Kaiser Sr. Advantage for 4 yrs.  Jan of the first year I was on this Kaiser plan  I had to pay $2,500 to pick up the first 30 day prescription of TKI because it put me in the "gap"  the remainder of the year it was $14.00 per mo.  The last 2 yrs have been $2,800 in Jan, which appears to be an increase not decreasing every year.   I pay nothing for PCR, Onc office visits are $5.00.   I wonder why Kaiser is not consistent in every area? 



#27 Susan61

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Posted 24 November 2014 - 06:50 PM

I worry about my cost of Gleevec when my husband stops working.  I have Aetna under my  husbands employment, therefore, my Medicare is my secondary insurance.  I have not picked up Part D, as from what I see it would cost me much more.  I know the day  is coming soon when my husband retires and we are both on Medicare.  Praying something better happens for everyone who is paying these hight prices.  I pay $112.00 for a 90 day supply of my Gleevec through Express Scripts under my husbands insurance, and sometimes I struggle to do that.  I feel for everyone who is paying these high prices, and would like to know how they do it.

Susan



#28 Trey

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Posted 25 November 2014 - 10:00 PM

The generic Gleevec will start selling in at least 2016, so the cost will decrease at that point.  How much will depend on competition.  Also I assume after July 2015 (patent expiration) it could be obtained legally in the U.S. from overseas generic vendors.



#29 pammartin

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Posted 26 November 2014 - 06:07 PM

How safe are the overseas generic vendors and how can one know they are getting the correct med?  I know nothing of buying out of the country. 



#30 gerry

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Posted 26 November 2014 - 08:12 PM

Canada approved generic Gleevec in 2013 - haven't seed the outcome of their survery yet.

http://cmlsociety.or...rive-in-canada/






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