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Medicare Part D and Sprycel


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#1 hannibellemo

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Posted 07 February 2017 - 05:34 PM

Hi, everyone. Just got my first Sprycel order through Medicare Part D. I choose Humana as my Part D provider because they were cheapest and had everything I take on their formulary. I pay $17.00/mo. with a $400 deductible.

 

I don't have to use a specialty pharmacy I just used my regular pharmacy.  I paid approximately 30% or $2340.43 of the retail price, $7816.99. Reminder, this is for 50 mg.

 

Next month will be more because I will be in and out of the "donut hole". After that point I should pay between $300 and $400 per month depending on what other drug gets refilled at the same time.

 

That's way more than I was paying before I retired, but I also think it may be way less than some are paying now with private insurance.

 

I don't know what the answer is to this country's medical/pharmaceutical/insurance costs problem

but I hope whatever Congress comes up with is more than the "something terrific" lip service we have gotten so far.


Pat

 

"You can't change the direction of the wind but you can adjust your sails."

DX 12/08; Gleevec 400mg; liver toxicity; Sprycel 100mg.; CCyR 4/10; MMR 8/10; Pleural Effusion 2/12; Sprycel 50mg. Maintaining MMR; 2/15 PCRU; 8/16 drifting in and out of undetected like a wave meeting the shore. Retired 12/23/2016! 18 months of PCRU, most recent at Mayo on 7/25/17 was negative at their new sensitivity reporting of 0.003.<p>


#2 Buzzm1

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Posted 07 February 2017 - 07:15 PM

Pat, thank you for posting that information regarding your Medicare drug transaction.  Please continue to do so.


For the benefit of yourself and others please add your CML history into your Signature

 

02/2010 Gleevec 400mg

2011 Two weakly positives, PCRU, weakly positive

2012 PCRU, PCRU, PCRU, PCRU

2013 PCRU, PCRU, PCRU, weakly positive

2014 PCRU, PCRU, PCRU, PCRU (12/07 began dose reduction w/each continuing PCRU)

2015 300, 250, 200, 150

2016 100, 50/100, 100, 10/17 TFR

2017 01/17 TFR, 04/18 TFR, 07/18 TFR 0.0012, 08/29 TFR 0.001, 10/17 TFR 0.000

2018 01/16 TFR 0.0004 ... next quarterly PCR 04/17

 

At the earliest opportunity, and whenever possible, lower your TKI dosage; TKIs are toxic drugs and the less we take longterm the better off we are going to be ... this is especially true for older adults.  

 

In hindsight I should have started my dosage reduction two years earlier; it might have helped minimize some of the longterm cumulative toxic effects of TKIs that I am beset with.  

 

longterm side-effects Peripheral Artery Disease - legs (it's a bitch); continuing shoulder problems, right elbow inflammation.   GFR and creatinine vastly improved after stopping Gleevec.

 

Cumulative Gleevec dosage estimated at 830 grams

 

Taking Gleevec 400mg an hour after my largest meal of the day helped eliminate the nausea that Gleevec is notorious for.  

 

Trey's CML BlogStopping - The OddsStop Studies - Discussion Forum Cessation Study

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#3 Jan0080

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Posted 07 February 2017 - 08:02 PM

Hanni,

Thanks for the post.

 

I am 66 but still covered by Corporate insurance.  My co-pay is $200 per month, which is very reasonable.

 

I am newly diagnosed, have been on Sprycel for 32 days without side effects.  My blood work has largely returned to normal with Myelocytes down to zero and my white count back in a normal range. I was fortunate to have a Dr that was having me get CBC's on a quarterly basis.  I was on an immune-suppressant that should have lowered my white cell count and yet it was going up.  The Myelocytes went from 4 on Dec 8th (I was asked to re-take the test) to 12 6 days later.  I was at the Hematologist's office the next day and then there was a fight with Blue Shield as to whether they would pay for Sprycel,  Proof of the Philadelphia chromosome won the day.  Thank goodness for billions spent on medical research.  However big pharm is a bunch of gready b*stards.

 

At some point, I will be with Medicare and a good supplemental plan.  Do you have supplemental coverage?


Diagnosed Dec 27, 2016 started Sprycel 100 mg Jan 7, 2017. Initial PCR 77.9 after 30 days 28.4, day 79 1.4 and day 115 0.1%. That is a 99.9% reduction! Sprycel 100 mg for 3 months, 80 mg for 1 month and now at 50 mg. Hooray for Sprycel!!! PCR June 5, 2017 0.04! Dose reduction to 40 mg 6/15/2017 due to shortness of breath. 20 mg as of June 29th. PCR .02 9/11/2017. PCR .015 IS as of 12/11/2017. Lungs substantially better. Low dose Sprycel works!

Adverse Effect - At about week 6 of Sprycel sharp muscle pain that would start at 2 AM and last for about 4 hours. This lasted about 4 weeks and went away, thank goodness.

#4 shweflen

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Posted 07 February 2017 - 09:19 PM

I was diagnosed in October 2016.  I was on Medicare with Part D coverage through Humana.  My monthly premium was $18.40.  My first 30 days supply of Gleevec 400 mg had a retail cost of $9869,37 and I paid a copay of $2957.66.  In December I got 10 more 400 mg Gleevec at a retail cost of $3289.79 and a copay of $164.49.  On January 1st I changed Part D insurance to Express-Scripts because generic imatinib myslate was on their formulary and was not on Humana's.  My monthly premium is now $31.20.  I received 90 - 100 mg imatinib (3 per day) for a retail cost of $1593.82 and a copay of $698.45.  I anticipate the next 4 or 5 months to average about $800 per month and then drop to about $180 per month  because of the way the doughnut hole is calculated for generic drugs.


10/20/2016 BCR-ABL:ABL = 81.622

01/11/2017 BCR-ABL:ABL =   8.028

04/12/2017 BCR-ABL:ABL =   0.157

07/07/2017 BCR-ABL:ABL =   0.000

10/04/2017 BCR-ABL:ABL =   0.041

11/28/2017 BCR-ABL:ABL =   0.000

 

 


#5 Buzzm1

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Posted 07 February 2017 - 10:08 PM

I received 90 - 100 mg (generic) imatinib (3 per day) for a retail cost of $1593.82 and a copay of $698.45.  I anticipate the next 4 or 5 months to average about $800 per month and then drop to about $180 per month  because of the way the doughnut hole is calculated for generic drugs.

Shweflen, thank you for all of the info; that's by far the lowest cost on generic imatinib that I have seen .. do you know which manufacturer of generics it was from?  

 

if I am correct, regarding your $698.45 payment
assuming a $400 deductible, plus 25% of the remaining $1193.82 ='s $698.45

 

if my assumptions are correct and the generic imatinib pricing remains the same, your next refill should cost:

25% of $1593.82 ='s $398.45

 

and should remain so, until you enter the donut hole after $3700 out-of-pocket*

during the donut hole ($3700 to $4950) you will pay 51% of the cost of the generic

after you exit the donut hole at $4950 out-of-pocket* and reach catastrophic your refill should cost 5% of $1593.82 ='s $79.61

 

*Note: out-of-pocket calculation may include some insurance coverage


For the benefit of yourself and others please add your CML history into your Signature

 

02/2010 Gleevec 400mg

2011 Two weakly positives, PCRU, weakly positive

2012 PCRU, PCRU, PCRU, PCRU

2013 PCRU, PCRU, PCRU, weakly positive

2014 PCRU, PCRU, PCRU, PCRU (12/07 began dose reduction w/each continuing PCRU)

2015 300, 250, 200, 150

2016 100, 50/100, 100, 10/17 TFR

2017 01/17 TFR, 04/18 TFR, 07/18 TFR 0.0012, 08/29 TFR 0.001, 10/17 TFR 0.000

2018 01/16 TFR 0.0004 ... next quarterly PCR 04/17

 

At the earliest opportunity, and whenever possible, lower your TKI dosage; TKIs are toxic drugs and the less we take longterm the better off we are going to be ... this is especially true for older adults.  

 

In hindsight I should have started my dosage reduction two years earlier; it might have helped minimize some of the longterm cumulative toxic effects of TKIs that I am beset with.  

 

longterm side-effects Peripheral Artery Disease - legs (it's a bitch); continuing shoulder problems, right elbow inflammation.   GFR and creatinine vastly improved after stopping Gleevec.

 

Cumulative Gleevec dosage estimated at 830 grams

 

Taking Gleevec 400mg an hour after my largest meal of the day helped eliminate the nausea that Gleevec is notorious for.  

 

Trey's CML BlogStopping - The OddsStop Studies - Discussion Forum Cessation Study

Big PhRMA - Medicare Status - Social Security Status - Deficit/Debt


#6 kat73

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Posted 08 February 2017 - 11:31 AM

Wow.  Although I avidly follow, I never post in this area, as my understanding of the world of insurance is nil.  But I know enough to know that we have a real and terrible problem in this country (US) and we must solve it.  I have the sheer good luck to be on my husband's Blue Cross/Blue Shield Federal Employee Plan and do you know what I pay for 90 days of any TKI?  $95.  How can there be such a vast gap in coverage?  Yes, I know all the reasons - huge group, ability to negotiate prices, etc.  But still.  Bottom line:  the pills cost cents to make and, last I looked, Sprycel was $230 a pill.  I pay essentially $1.00 a pill.  Others on here pay so, so, so much more and yet must accept that as reasonable.  It's an evil labyrinth full of willful obfuscation.  I wish I had a solution.


Dx July 2009 on routine physical.  WBC 94.  Started Gleevec 400 mg Sept 2009.  MMR at 2yrs.  Side effects (malaise, depression/anxiety, fatigue, nausea, periorbital edema) never improved.  Kidney issues developed because of Gleevec.  Switched to Sprycel 70 mg in Aug 2011.  Above side effects disappeared or improved.  Have been MR3.5 - 4.5 ever since.  Two untreated pleural effusions followed by one treated by stopping Sprycel Jan 2017.  After 9 weeks, PCR showed loss of MMR; re-started Sprycel at 50 mg and in 3 months was back to <0.01% IS.  Pleural effusion returned within a couple of months, same as before (moderate, left side only).  Stopped Sprycel 50 mg for 12 weeks; pleural effusion resolved.  At about a monthoff the drug, PCR was 0.03; at 11 weeks it was 2.06 - lost CCyR? Have returned to 50 mg Sprycel for 3 weeks, intending to reduce to 20 mg going forward.


#7 Dona_B

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Posted 08 February 2017 - 04:00 PM

My husband's comments about never being able to retire are beginning to make sense.

 

I too hope that this administration can fix the problem but feel like even if they all would want to, it will require supernatural help. The problem has gone on far too long and too much money can be made on chronic illness.


DX 1/14; Sprycel 100 Mg, liver toxicity; Sprycel 80 Mg; down to 50 Mg for 5 months. Numbers going up. Back to 80 Mg 10/16 (with 50s slipped in to use up) BCR/ABL: .0047 12/15; .0302 4/16;  .0528 8/16;  .084 10/16; .045, 1/17 back up on 80 mg Sprycel; .006, 3/17; .016, 7/17; Shingles 8/17


#8 shweflen

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Posted 08 February 2017 - 05:24 PM

Shweflen, thank you for all of the info; that's by far the lowest cost on generic imatinib that I have seen .. do you know which manufacturer of generics it was from?  

 

if I am correct, regarding your $698.45 payment
assuming a $400 deductible, plus 25% of the remaining $1193.82 ='s $698.45

 

if my assumptions are correct and the generic imatinib pricing remains the same, your next refill should cost:

25% of $1593.82 ='s $398.45

 

and should remain so, until you enter the donut hole after $3700 out-of-pocket*

during the donut hole ($3700 to $4950) you will pay 51% of the cost of the generic

after you exit the donut hole at $4950 out-of-pocket* and reach catastrophic your refill should cost 5% of $1593.82 ='s $79.61

 

*Note: out-of-pocket calculation may include some insurance coverage

Buzzm1, The imatinib manufacturer is Apotex and I bought it through the local Walmart retail pharmacy.  The insurance company's quote for copay from their mail order pharmacy was $3193.73 and their preferred retail pharmacy, Walgreen, was also much higher.  I think your calculations are right on the money.  The estimates provided on the Medicare Part D Plan Finder that I used to select a new insurer are similar to your results.  My experience is that the estimates on the Plan Finder are better than those provided by the insurance companies or the doctor's office.


10/20/2016 BCR-ABL:ABL = 81.622

01/11/2017 BCR-ABL:ABL =   8.028

04/12/2017 BCR-ABL:ABL =   0.157

07/07/2017 BCR-ABL:ABL =   0.000

10/04/2017 BCR-ABL:ABL =   0.041

11/28/2017 BCR-ABL:ABL =   0.000

 

 


#9 hannibellemo

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Posted 09 February 2017 - 07:53 AM

Jan,

 

Congratulations on your excellent progress! I wish I had taken advantage of our free blood work every year, (I usually just got the flu shot), my CML would have been found much earlier.

 

Yes, I have a supplemental. I chose Blue Cross Blue Shield (Wellmark here in Iowa) plan F because of the coverage. Also, because we are only 90 minutes away from Mayo-Rochester and they don't accept Medicare unless you have been seen by them within the past two years prior to Medicare. (Something like that, anyway.) They will definitely charge the 15% up charge and I want to keep seeing my onc there once a year. Also, because we've always had Wellmark and I've never had a problem with coverage for anything.

 

I pay $104 per month for the supplemental. (Buzz, that's for your information). Steve, who is 2 years older, pays $140/mo. for the same supplemental. We are both non-smokers.

 

Kat73, I understand what you are saying! When I was working I paid $1,000 out of pocket for everything! We did not have a separate pharmaceutical plan, everything was covered under major medical. I covered that $1,000 through our Flex program and I paid NOTHING for medical care for the remainder of the year. For several years I paid nothing towards my family plan insurance cost. By the time I retired I was paying a whopping $126/mo. I hope you caught the sarcasm!

 

My DIL, because her coverage is better, pays over $600/mo. for their family insurance! This is crazy, why should there be such discrepancies?

 

On the other hand, if it weren't for the fact that everyone would have coverage, I'm not a big fan of national health plans; there are many drawbacks to those.


Pat

 

"You can't change the direction of the wind but you can adjust your sails."

DX 12/08; Gleevec 400mg; liver toxicity; Sprycel 100mg.; CCyR 4/10; MMR 8/10; Pleural Effusion 2/12; Sprycel 50mg. Maintaining MMR; 2/15 PCRU; 8/16 drifting in and out of undetected like a wave meeting the shore. Retired 12/23/2016! 18 months of PCRU, most recent at Mayo on 7/25/17 was negative at their new sensitivity reporting of 0.003.<p>


#10 Floa7

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Posted 09 February 2017 - 01:57 PM

My son and I both have CML. My son gets his sprycel 70 mg thru Diplomatic  Specialty Pharmacy. He is disabled and is on Medicare also has the Part D insurance thru Humana. And the balance on his sprycel is paid for thru Leukemia Assistance Programs after Humana pays.

 

Your Social Worker at the cancer center knows all about the assistance programs.


1 2012 CML detected Started Gleevec 400 mg

In nov 2014 my pcr started to rise by Feb I stopped Gleevec and went onto

2 2015 Tasigna 600 mg/day

I have been PCRU for 2 years and stopped Tasigna 4 7 2017

5 8 2017 results 0.008

5 30 2017 results 0.028 

6 30 2017 results 0.3, I have restarted the Tasigna because it went above 0.1 

 

My son

11 2011 CML detected Started Gleevec 400 mg

He went 2 1/2 years on gleevec and lost PCRU

Started Sprycel went PCRU for 2 years and stopped the Sprycel, went back for 3 month checkup and PCR was 8.0

He went back onto Sprycel and now is PCRU again

3 16 2017 results 0.008

6 1 2017 results 0.002


#11 Buzzm1

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Posted 10 February 2017 - 07:45 AM

Pat & Shweflen, please check your Medicare Part D statement, when issued by your drug plan, usually after the end of the month when you have used your Medicare drug plan, to see what your to-date total out-of-pocket is.  That will tell you where you are in relation to reaching the catastrophic phase (after $4950 out-of-pocket) where your refills will only cost 5% of the prescription cost.  Note: it will also help us figure out how they calculate out-of-pocket cost (which includes at least some of what your plan paid).


For the benefit of yourself and others please add your CML history into your Signature

 

02/2010 Gleevec 400mg

2011 Two weakly positives, PCRU, weakly positive

2012 PCRU, PCRU, PCRU, PCRU

2013 PCRU, PCRU, PCRU, weakly positive

2014 PCRU, PCRU, PCRU, PCRU (12/07 began dose reduction w/each continuing PCRU)

2015 300, 250, 200, 150

2016 100, 50/100, 100, 10/17 TFR

2017 01/17 TFR, 04/18 TFR, 07/18 TFR 0.0012, 08/29 TFR 0.001, 10/17 TFR 0.000

2018 01/16 TFR 0.0004 ... next quarterly PCR 04/17

 

At the earliest opportunity, and whenever possible, lower your TKI dosage; TKIs are toxic drugs and the less we take longterm the better off we are going to be ... this is especially true for older adults.  

 

In hindsight I should have started my dosage reduction two years earlier; it might have helped minimize some of the longterm cumulative toxic effects of TKIs that I am beset with.  

 

longterm side-effects Peripheral Artery Disease - legs (it's a bitch); continuing shoulder problems, right elbow inflammation.   GFR and creatinine vastly improved after stopping Gleevec.

 

Cumulative Gleevec dosage estimated at 830 grams

 

Taking Gleevec 400mg an hour after my largest meal of the day helped eliminate the nausea that Gleevec is notorious for.  

 

Trey's CML BlogStopping - The OddsStop Studies - Discussion Forum Cessation Study

Big PhRMA - Medicare Status - Social Security Status - Deficit/Debt


#12 BarbaraB

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Posted 10 February 2017 - 12:04 PM

My husband's comments about never being able to retire are beginning to make sense.

 

I too hope that this administration can fix the problem but feel like even if they all would want to, it will require supernatural help. The problem has gone on far too long and too much money can be made on chronic illness.

Dona, 

My husband says the same thing.  He has corporate Blue Cross and his copay is $80/month for Sprycel 100mg.  He was going to leave that position because of huge job stress and nasty management/boss and start his own business this year...but alas....was diagnosed a month ago with CML and now he feels "stuck".  he has to remain in his job to be able to afford his meds. 


Husband's Diagnosis: 1/11/2017- WBC 211,000.  Hydroxyurea 500 bid & Allopurinol started.

1/16 - BMB- FISH = 95% bcr/abl. 1% blasts.   Sprycel 100 mg added to hydroxyurea

1/27  WBC = 54,000 -- hydroxy stopped.

2/3   WBC = 8

2/9= Hematologic Response !! WBC= 5, platelets= 300, peripheral smear no abnormal cells. Allopurinol stopped.

 

 

 


#13 chriskuo

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Posted 10 February 2017 - 11:38 PM

If you have another job lined up with good insurance, it is feasible to switch jobs.  But without an employer group plan, the copays for TKIs are almost always many many times higher over the course of a year.



#14 hannibellemo

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Posted 11 February 2017 - 07:55 AM

Buzz,

 

You can also go on the Medicare website and enter all of your drugs and get a chart that will tell you approximately the same thing for all of the Part D providers you may be considering at the time. I will try it just for Sprycel and see what I get.

 

Just noticed that Shweflen posted about the plan finder earlier.


Edited by hannibellemo, 11 February 2017 - 07:59 AM.

Pat

 

"You can't change the direction of the wind but you can adjust your sails."

DX 12/08; Gleevec 400mg; liver toxicity; Sprycel 100mg.; CCyR 4/10; MMR 8/10; Pleural Effusion 2/12; Sprycel 50mg. Maintaining MMR; 2/15 PCRU; 8/16 drifting in and out of undetected like a wave meeting the shore. Retired 12/23/2016! 18 months of PCRU, most recent at Mayo on 7/25/17 was negative at their new sensitivity reporting of 0.003.<p>


#15 hannibellemo

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Posted 11 February 2017 - 07:57 AM

Floa7,

 

Thanks for posting; that is excellent information!


Pat

 

"You can't change the direction of the wind but you can adjust your sails."

DX 12/08; Gleevec 400mg; liver toxicity; Sprycel 100mg.; CCyR 4/10; MMR 8/10; Pleural Effusion 2/12; Sprycel 50mg. Maintaining MMR; 2/15 PCRU; 8/16 drifting in and out of undetected like a wave meeting the shore. Retired 12/23/2016! 18 months of PCRU, most recent at Mayo on 7/25/17 was negative at their new sensitivity reporting of 0.003.<p>


#16 shweflen

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Posted 11 February 2017 - 02:14 PM

Pat & Shweflen, please check your Medicare Part D statement, when issued by your drug plan, usually after the end of the month when you have used your Medicare drug plan, to see what your to-date total out-of-pocket is.  That will tell you where you are in relation to reaching the catastrophic phase (after $4950 out-of-pocket) where your refills will only cost 5% of the prescription cost.  Note: it will also help us figure out how they calculate out-of-pocket cost (which includes at least some of what your plan paid).

Buzzm1,  for some reason i can't copy & past the statement here nor can I attach a word document I copied it to but, the information is pretty straightforward.  For 90 - 100 mg imatinib tablets (1 months supply) the insurance company paid $1593.82 of which my copay was $698.45.  The statement shows $400 applied to the deductible leaving no balance in Stage 1.  It shows $1593.82 applied to the $3700 limit in Stage 2 to reach the Coverage Gap so there is a balance in Stage 2 of $2106.18.  It also shows $698.45 applied to the "out of pocket responsibility" limit of $4950 leaving a balance of $4252.55 before I reach the Catastrophic coverage or Stage 4.  It appears that the insurance company cost is applied to the Stage 2 limit but only my actual out of pocket cost is applied to the Coverage Gap limit.  I think then, that the next month I will pay 25% of $1593.82 then the third month I would pay 25% of $512.36 + 51% of $1081.46.  The 4th, 5th and 6th months I would pay 51% of $1593.82 then in the 7th month I would pay some combination of 51% of the remainder of the $4950 limit on the Coverage Gap and 5% of some other number.  The 8th through the 12th month I would pay 5% of the $1593.82 and then, of course, start all over again.


10/20/2016 BCR-ABL:ABL = 81.622

01/11/2017 BCR-ABL:ABL =   8.028

04/12/2017 BCR-ABL:ABL =   0.157

07/07/2017 BCR-ABL:ABL =   0.000

10/04/2017 BCR-ABL:ABL =   0.041

11/28/2017 BCR-ABL:ABL =   0.000

 

 


#17 Buzzm1

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Posted 11 February 2017 - 06:36 PM

Shweflen, thank you for the detailed information.  Yes, the question I was asking was in regard to the out-of-pocket total and when you would enter and exit the Coverage Gap, the so-called Donut Hole, from $3700 to $4950.  In 2016, when you ordered and paid for the 10 400mg tablets, you were already in Catastrophic phase, Stage 4, as you only paid 5% of the cost (My first 30 days supply of Gleevec 400 mg had a retail cost of $9869,37 and I paid a copay of $2957.66.  In December I got 10 more 400 mg Gleevec at a retail cost of $3289.79 and a copay of $164.49).  Therein lies my confusion. While it is true that you are now on a different Medicare Part D insurance, I don't think it would make that much of a difference.  We'll find out for sure in your 4th month.


For the benefit of yourself and others please add your CML history into your Signature

 

02/2010 Gleevec 400mg

2011 Two weakly positives, PCRU, weakly positive

2012 PCRU, PCRU, PCRU, PCRU

2013 PCRU, PCRU, PCRU, weakly positive

2014 PCRU, PCRU, PCRU, PCRU (12/07 began dose reduction w/each continuing PCRU)

2015 300, 250, 200, 150

2016 100, 50/100, 100, 10/17 TFR

2017 01/17 TFR, 04/18 TFR, 07/18 TFR 0.0012, 08/29 TFR 0.001, 10/17 TFR 0.000

2018 01/16 TFR 0.0004 ... next quarterly PCR 04/17

 

At the earliest opportunity, and whenever possible, lower your TKI dosage; TKIs are toxic drugs and the less we take longterm the better off we are going to be ... this is especially true for older adults.  

 

In hindsight I should have started my dosage reduction two years earlier; it might have helped minimize some of the longterm cumulative toxic effects of TKIs that I am beset with.  

 

longterm side-effects Peripheral Artery Disease - legs (it's a bitch); continuing shoulder problems, right elbow inflammation.   GFR and creatinine vastly improved after stopping Gleevec.

 

Cumulative Gleevec dosage estimated at 830 grams

 

Taking Gleevec 400mg an hour after my largest meal of the day helped eliminate the nausea that Gleevec is notorious for.  

 

Trey's CML BlogStopping - The OddsStop Studies - Discussion Forum Cessation Study

Big PhRMA - Medicare Status - Social Security Status - Deficit/Debt


#18 shweflen

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Posted 11 February 2017 - 08:52 PM

Buzzm1,  I don't understand it either.  I went back and looked at my 12/31/2016 statement from Humana and in one place it says my "out-of -pocket" costs for the year were $5164.92 and in another place it says that the amount I paid was $3179.91 (which is what I actually paid for according to my records for the Gleevec plus some other small dollar prescriptions).  Somehow, I think, the total "out of pocket" towards the coverage gap limit includes a discount to the insurer by the manufacturer.  The 2016 Medicare language says that the Initial coverage period "ends when maximum prescription costs paid by you/your plan/others reach $3,310"  while "coverage gap ends when maximum paid by you/others on your behalf reaches $4,850."  If you can figure it out, let me know.


10/20/2016 BCR-ABL:ABL = 81.622

01/11/2017 BCR-ABL:ABL =   8.028

04/12/2017 BCR-ABL:ABL =   0.157

07/07/2017 BCR-ABL:ABL =   0.000

10/04/2017 BCR-ABL:ABL =   0.041

11/28/2017 BCR-ABL:ABL =   0.000

 

 


#19 Buzzm1

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Posted 11 February 2017 - 09:15 PM

Shweflen, the Coverage Gap (Donut Hole) for 2016 was $3310 to $4850.  Payment during the 2016 Donut Hole was 45% for brand name drugs and 58% for generics.  Somehow your first payment of $2957.66 in 2016 was enough for you to clear the $4850 Coverage Gap/Donut Hole.  How that was calculated remains the question.  We're clear on payments until the Coverage Gap is reached.  This will be a learning experience for both of us, as well as many others.  


For the benefit of yourself and others please add your CML history into your Signature

 

02/2010 Gleevec 400mg

2011 Two weakly positives, PCRU, weakly positive

2012 PCRU, PCRU, PCRU, PCRU

2013 PCRU, PCRU, PCRU, weakly positive

2014 PCRU, PCRU, PCRU, PCRU (12/07 began dose reduction w/each continuing PCRU)

2015 300, 250, 200, 150

2016 100, 50/100, 100, 10/17 TFR

2017 01/17 TFR, 04/18 TFR, 07/18 TFR 0.0012, 08/29 TFR 0.001, 10/17 TFR 0.000

2018 01/16 TFR 0.0004 ... next quarterly PCR 04/17

 

At the earliest opportunity, and whenever possible, lower your TKI dosage; TKIs are toxic drugs and the less we take longterm the better off we are going to be ... this is especially true for older adults.  

 

In hindsight I should have started my dosage reduction two years earlier; it might have helped minimize some of the longterm cumulative toxic effects of TKIs that I am beset with.  

 

longterm side-effects Peripheral Artery Disease - legs (it's a bitch); continuing shoulder problems, right elbow inflammation.   GFR and creatinine vastly improved after stopping Gleevec.

 

Cumulative Gleevec dosage estimated at 830 grams

 

Taking Gleevec 400mg an hour after my largest meal of the day helped eliminate the nausea that Gleevec is notorious for.  

 

Trey's CML BlogStopping - The OddsStop Studies - Discussion Forum Cessation Study

Big PhRMA - Medicare Status - Social Security Status - Deficit/Debt


#20 Buzzm1

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Posted 12 February 2017 - 12:25 AM

Costs in the coverage gap https://www.medicare...verage-gap.html

 

Note: Although you'll pay no more than 40% of the price for the brand-name drug in 2017, 95% of the price—what you pay plus the 50% manufacturer discount payment—will count as out-of-pocket costs which will help you get out of the coverage gap. These items aren't counted toward your out-of-pocket spending:

 

For generic drugs, only the amount you pay will count toward getting you out of the coverage gap.


For the benefit of yourself and others please add your CML history into your Signature

 

02/2010 Gleevec 400mg

2011 Two weakly positives, PCRU, weakly positive

2012 PCRU, PCRU, PCRU, PCRU

2013 PCRU, PCRU, PCRU, weakly positive

2014 PCRU, PCRU, PCRU, PCRU (12/07 began dose reduction w/each continuing PCRU)

2015 300, 250, 200, 150

2016 100, 50/100, 100, 10/17 TFR

2017 01/17 TFR, 04/18 TFR, 07/18 TFR 0.0012, 08/29 TFR 0.001, 10/17 TFR 0.000

2018 01/16 TFR 0.0004 ... next quarterly PCR 04/17

 

At the earliest opportunity, and whenever possible, lower your TKI dosage; TKIs are toxic drugs and the less we take longterm the better off we are going to be ... this is especially true for older adults.  

 

In hindsight I should have started my dosage reduction two years earlier; it might have helped minimize some of the longterm cumulative toxic effects of TKIs that I am beset with.  

 

longterm side-effects Peripheral Artery Disease - legs (it's a bitch); continuing shoulder problems, right elbow inflammation.   GFR and creatinine vastly improved after stopping Gleevec.

 

Cumulative Gleevec dosage estimated at 830 grams

 

Taking Gleevec 400mg an hour after my largest meal of the day helped eliminate the nausea that Gleevec is notorious for.  

 

Trey's CML BlogStopping - The OddsStop Studies - Discussion Forum Cessation Study

Big PhRMA - Medicare Status - Social Security Status - Deficit/Debt





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