88 replies to this topic

[chriskuo]

The 5% copay in catastrophic is great for generics.

[Buzzm1]

2018 Social Security COLA calculation
2017 Q3 us the average of July 238.617 August 239.448 and September http://bit.ly/2tPkeTb

2016 Q3 235.057

2017 Q3 divided by 2016 Q3 equals the 2018 SS COLA

 

The September CPI-W number will be released on Oct. 13.

 

2018 Social Security COLA increase expected for retirees http://bit.ly/2x3jx8S

 

For most Social Security recipients, the 2018 COLA increase will be offset by Medicare and Medicare supplemental increases.

 

New subscribers to Medicare are paying $134/mo.

[shweflen]

Does anyone know when the 2018 Part D Plan information will be available on the Medicare Plan Finder site?

[Buzzm1]

Does anyone know when the 2018 Part D Plan information will be available on the Medicare Plan Finder site?

shweflen, November is when new Medicare information becomes available.  

[Buzzm1]

Does anyone know when the 2018 Part D Plan information will be available on the Medicare Plan Finder site?

Make that, on, or around, Oct. 15th,   

[hannibellemo]

RedH,

 

I have Humana, $17/mo. and if you look back on page 2 or 3 of this thread you will find my out of pocket costs. My catastrophic co-pay is around $324/mo. for 50mg Sprycel.

 

http://community.lls...-sprycel/page-2

 

The posts are actually under Buzz, I started a new post and he consolidated it where it should have been.

 

Good luck!

[shweflen]

date       Rx                total cost         I paid      deductible YTD       phase 2 YTD       coverage gap YTD

 

1/24     imatinib           1593.82       698.45         400.00                     1593.82                   698.45

2/27     imatinib           1592.82       398.45                                         3187.69                 1096.90

3/9       misc                    10.00         10.00                                         3197.69                  1106.90

3/9       misc                    37.43         37.43                                         3235.12                  1144.33

3/28     imatinib           1593.82       691.96                                         3700.00                  1836.29

4/21     imatinib           1593.82       812.85                                                                        2649.18

4/27     misc                    18.85           9.62                                                                        2658.76

5/31     imatinib           1593.82       812.85                                                                        3471.61

6/12     misc                    10.00           5.10                                                                        3476.71

6/13     misc                    37.43          19.09                                                                       3495.80

7/3       imatinib           1593.82        812.85                                                                       4308.65

7/28     imatinib           1593.82        658.16                                                                       4950.00

 

I am now in the catastrophic phase of Part D coverage.  The most recent cost of $658.16 includes 51% of $1257.54 and then 5% of $336.28.  My next 5 prescriptions should each cost 5% of $1593.82 or $79.69.

 

On my receipt from Walmart it shows  "Cash:  $7304.75"  which I assume would be the cost without insurance. 

 

My premium for Express-Scripts for this year is $31.20 per month.                                                               

I finally got into the "catastrophic" phase of Part D and am paying 5% of the total price for imatinib myslate.  On August 3 I picked up a 30 day supply (OK'd via a vacation waiver) and paid $79.69 or 5% of $1593.82 (which is what the total price had been for the 7 previous months).  Imagine my surprise when my wife picked up the next 30 day prescription on September 28 and my cost was $252.24 which was 5% of a total cost of $5044.87.  When I asked for an explanation they told me that they couldn't get the imatininb from the previous supplier (Apotex) and instead had gotten it from Sun Pharmaceuticals and that that the difference between $1593.82 and $5044.87 was just the difference between suppliers of the same generic drug.  I called Express-Scripts, my insurer, and was told that that was just the way it was.  They said that when they checked other pharmacies in the area that the cost, regardless of the manufacturer, were higher than the cost of Sun Pharmaceuticals imatinib from WalMart.  I will pay the $252.24 if I have to but I don't know what I will do in January when I have to pay $400 plus 25% or later when I have to pay 51% of the higher number.  It is impossible to understand the relationships and negotiations among the pharmaceuticals, insurers, pharmacies and benefit managers and there is no one to whom you can appeal.  If I am lucky I will find a WalMart or Sam's Club that can get the imatinib from Apotex.  Maybe there will be a different, better plan available for next year but it is now apparent to me that the estimates on the Medicare Plan Finder are only good so long as the assumptions remain valid and if the pharmacies can't get the drugs from the sources they have deals with, all bets are off.

[Buzzm1]

Shweflen, that's a real bitch; there ought to be a law.  It seems like there might be some chicanery going on; something that is preventing Apotex from supplying the market with generic imatinib at the previously agreed-upon price.  If You don't have success at locating Apotex generic imatinib at the reduced price I would suggest contacting your Congressperson and asking them to get involved.  With Republicans currently in charge there's a push to drive more money to the drug manufacturers at the expense of the patients.  For 2018, it will be 44% of the drug cost while you are in the donut hole, but that's not going to do anything for you in the catastrophic phase.  I was hoping that there would be a further reduction in the generic imatinib price in 2018.  

 

Wondering if Dom will encounter the same problem ... he also has Express Scripts/Walmart.

[shweflen]

I finally got into the "catastrophic" phase of Part D and am paying 5% of the total price for imatinib myslate.  On August 3 I picked up a 30 day supply (OK'd via a vacation waiver) and paid $79.69 or 5% of $1593.82 (which is what the total price had been for the 7 previous months).  Imagine my surprise when my wife picked up the next 30 day prescription on September 28 and my cost was $252.24 which was 5% of a total cost of $5044.87.  When I asked for an explanation they told me that they couldn't get the imatininb from the previous supplier (Apotex) and instead had gotten it from Sun Pharmaceuticals and that that the difference between $1593.82 and $5044.87 was just the difference between suppliers of the same generic drug.  I called Express-Scripts, my insurer, and was told that that was just the way it was.  They said that when they checked other pharmacies in the area that the cost, regardless of the manufacturer, were higher than the cost of Sun Pharmaceuticals imatinib from WalMart.  I will pay the $252.24 if I have to but I don't know what I will do in January when I have to pay $400 plus 25% or later when I have to pay 51% of the higher number.  It is impossible to understand the relationships and negotiations among the pharmaceuticals, insurers, pharmacies and benefit managers and there is no one to whom you can appeal.  If I am lucky I will find a WalMart or Sam's Club that can get the imatinib from Apotex.  Maybe there will be a different, better plan available for next year but it is now apparent to me that the estimates on the Medicare Plan Finder are only good so long as the assumptions remain valid and if the pharmacies can't get the drugs from the sources they have deals with, all bets are off.

I talked to the pharmacy manager at WalMart yesterday and he is now able to get the Apotex version of imatinib again so he said he would go ahead and order it in preparation for filling my next month's prescription.  Good news on that front.

 

I have started looking at Part D coverage for next year.  On the Medicare Plan Finder it appeared that the lowest overall cost for me would be a Cigna plan and their mail order pharmacy.  Since it showed up on the Plan Finder as meeting my needs with the medications & dosages I use I assumed it was OK.  But, just to be sure I looked on the Cigna website and found that their formulary says 100 mg imatininb is quantity limited to 60 pills per month.  Since I take 300 mg per day, that won't work.  I called Cigna to ask whether the on line formulary was accurate and was told that it was and that if I needed 90 pills per month I would have to ask for prior authorization.  I asked if authorization was routinely given with a doctor's explanation and was told that the only way to find out was to enroll in their policy and then ask.  Another case of "you have to buy it to know what's in it."