14 replies to this topic

[Dom]

Hello everyone.

 

My oncologist told me about this site.  So happy to find it.  I was diagnosed with CML exactly one year ago, and I've been on Gleevec since then.  God bless Brian Drucker!

 

I wonder if anyone here is in the position I'm in.  I will lose my job and insurance at the end of February 2015.  I plan to go on Cobra for the next 18 months, and then get my own insurance for about 10 months, and then medicare.  

 

Does anyone have advice on private insurance?

 

As for medicare, when I look at the government site, it looks like it will cost me $8,000 a year.  Is anyone else on medicare?  

 

Thanks for any help you can give me

 

Dom

 

 

[SusanL]

welcome.  You will received lots of information and encouragement here

Go to 2nd page and subject is "Gleevec and Medicare"  lots of good information.  Seems to differ tho, no 2 have the same experience.

My cost with Medicare and a supplemental, which is the usual way most people go on medicare, is $2,600 lump sum when I hit donut hole in Jan and then $12.00 per mo for Bosulif.  All CML drugs seem around the same costs per mo.

[Buzzm1]

Hi Dom,

 

as you likely know, Gleevec will go generic in the U.S. on Feb. 1, 2016

 

with regards to Medicare and the coverage gap

 

http://www.medicare....gs-in-2020.html

 

Buzz

[roamingdoc83]

Dom,

One year and going strong. Outstanding.

I was rather in the same boat as you. I was discovered 'while' on Cobra... ouch, not really considered 'insurance' as in 'changing to another private insurance' so I did not have any insurance from 2009, Oct - to now! I went without Gleevec for nearly two years... I made it originally for two plus years on 'stored' Gleevec (don't ask)... and then a friend supplied me for 8 months... anyway, you have a year or so to Medicare. Good deal.

If you have a tough time getting covered and cannot afford Gleevec, you can try Novartis' assistance program. I've been on it for a few months until I get Medicare and medigap (or whatever else I need)... had to pay out of pocket for my cancer for along time. Was not fun.

BE safe and keep going!

[Dom]

SusanL, thanks for the info. Looks like the perfect thread for me. Is your $12 / month the premium? If so, what is the copy for gleevec?

BuzzM, my oncologist thinks generic Gleevec won't drop in price all that much. I guess we'll have to wait and see.

Roaming, I'm a little concerned now. Won't cobra cover my gleevec? I thought it did. It's supposed to be seamless with the original insurance.

Thanks again to everyone.

[Buzzm1]

Dom,

 

Drugs are typically more expensive in the U.S. 

Novartis Gleevec U.S. 400mg is currently approx. $312/tablet

Novartis Gleevec Canada 400mg is $128/tablet

 

Generic elsewhere http://bit.ly/1vvuCg3

 

Buzz

[chriskuo]

SusanL.

 

Is somebody subsidizing your Medicare Part D plan or did you buy it individually?  

 

Your costs in catastrophic phase seem low for an individual or standard Medicare Part D plan.

My costs are similar for the year, but I pay low copays for the first 2 months and the copays are about $250/month

for the last 10 months.  My plan is subsidized by my former employer.

[hannibellemo]

Dom,

 

Your cobra should work just like your insurance does now except you will be footing the whole cost plus a fee (if your company does that). Good luck!

[roamingdoc83]

SusanL, thanks for the info. Looks like the perfect thread for me. Is your $12 / month the premium? If so, what is the copy for gleevec?

BuzzM, my oncologist thinks generic Gleevec won't drop in price all that much. I guess we'll have to wait and see.

Roaming, I'm a little concerned now. Won't cobra cover my gleevec? I thought it did. It's supposed to be seamless with the original insurance.

Thanks again to everyone.

 

 

Your Cobra will pay for Gleevec but 'Cobra' isn't like 'private' insurance. I was diagnosed while on Cobra, when i tried to get private I was told that 'basically' I had no private insurance so couldn't move to another private company. Kind of like Cobra severed by elligibility. You will be fine on Cobra for Gleevec.

[Dom]

Whew! Thanks for that, RoamingDoc! Wiping the sweat off my brow even as I type this.

[SusanL]

Dom and Chriskuo.

   When I retired my employer health ins stopped entirely.  I applied for medicare, including Part D.  and was told to choose which supplemental I wanted to go along with it.  It was up to me to research. I chose Kaiser.  The premium is taken out of my SS retirement check each mo.  I think it is around $100 - $120 per mo. This includes Part D for drug coverage.

    In the medicare booklet it states after they have paid out $2,500. for drugs (I honestly don't remember exact amount but it is in the booklet) you are  in the donut hole/gap where you then have to pay $4,500 before medicare, part D will pick up again.  Since all TKI's are in the $8,000 per mo range, I fall in the hole in Jan when I pick up my first refill for the year.  However, Kaiser only required me to pay $2,700 instead of $4,500.  From Feb - Dec it is $12.00 per mo co-payment the rest of the year.  This makes my total cost for TKI for the year, $2,844.  I have asked everyone I can at Kaiser who makes up that $1,800. between what I pay and what medicare says I will have to pay for donut hole, but no one has an answer.

  There are many financial aid resources out there to help with drug costs but I dont qualify.

   This is a very complex answer to a complex, confusing health insurance situation for those of us in this situation,  and as I said, everyone has a different experience and different costs.   I think it differs from state to state and regions within a state, like California

   If anyone knows something I don't please let us know.

[chriskuo]

From what I have seen, Kaiser has the most favorable coverage for +65 people with Medicare not subsidized by an employer.

Unfortunately, I have established doctors outside of Medicare.  Fortunately, my employer subsidizes Medicare Part D so the TKI cost is closer to what Susan L is paying with Kaiser.  In my case, I do not have to pay any donut hole, but the catastrophic phase is the standard 5%, rather than the $12/month at Kaiser.

 

Susan L, do you know if your Kaiser plan is a true Medicare supplement or a Medicare Advantage plan?

[SusanL]

I do know Kaiser Senior Advantage is what I have.  Not sure what you mean by "true Medicare supplement".  

When you total it out for the year, you are paying $1,360 more than I do.

[Buzzm1]

I do know Kaiser Senior Advantage is what I have. 

 

SusanL,

 

I'm looking at subscribing to the Kaiser Permanente Senior Advantage (HMO)... 

for 2015 http://bit.ly/1ykYNBc

Medicare is $104.90/mo. deducted from SS

KPSA (HMO) monthly premium is $69/mo. (area dependent?, includes Medicare Part D)

optional Advantage Plus monthly premium is $20/mo. (dental, hearing, vision, fitness)

 

cost for Tier 5 brand-name & specialty drugs: (i.e. Gleevec $9,350/30 days 400mg)

 

Initial Coverage Stage

(for up to a 30-day supply)

 

$5 preferred generic

$15 nonpreferred generic

$45 preferred brand-name

$95 nonpreferred brand-name

25% coinsurance for specialty

$0 injectable Part D vaccines

When the total drug costs paid by you and any Part D plan reach $2,960, you move into the Coverage Gap Stage.

 

Coverage Gap Stage http://1.usa.gov/1KNPbpm (it's complicated)

(for up to a 30-day supply)

 

$5 preferred generic

$15 nonpreferred generic

You pay 45% for brand-name & specialty drugs (including a portion of the dispensing fee)

$0 injectable Part D vaccines

If your annual out-of-pocket costs reach $4,700, you move into the Catastrophic Coverage Stage

 

Catastrophic Coverage Stage

When your annual out-of-pocket costs exceed $4,700, you pay lower cost shares for the remainder of the calendar year.

 

$5 generic

$12 brand-name & specialty

$0 injectable Part D vaccines

 

Feb. 1, 2016 generic Gleevec

 

Buzz

[SusanL]

Yes, bottom line, it is VERY confusing.  My first year on Medicare, when I went to local Kaiser pharmacy to pick up presc. they looked at it and had to have a conference in back room to decide how much my payment would be.  The girls came out and sheepishly said.  "does $2,800. sound ok???"  They must not get many of these the first week in Jan.

All I know is all the literature says, while in the gap I pay $4,500 and after that catastrophic coverage starts and I pay $12. However, Kaiser has never charged me more than $2,800.  I have no idea why, and I'm not going to question it.  I sure hope no representative from Kaiser is reading all this and saying...."better look into this".