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Anyone on Tasigna have Aetna? My copay just went from $70 to $800!!!


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#1 jamesm

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Posted 29 September 2011 - 10:10 AM

According to a rep at Aetna, Tasigna was reclassified into a specialty "tier" where the patient is now responsible for 10% of the cost effective 9/1. They are telling me the new copay is $800 / month from $70??? No heads up, no letter, no email!

Has anyone with Aetna run into this?

I am freaking out right now!!!



#2 CallMeLucky

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Posted 29 September 2011 - 10:11 AM

Check if your plan has an annual out of pocket maximum.


Date  -  Lab  -  Scale  -  Drug  -  Dosage MG  - PCR
2010/Jul -  MSKCC  -  Non-IS  -  Gleevec  - 400 - 1.2%
2010/Oct -  MSKCC  -  Non-IS  -  Gleevec  - 400 - 0.25%
2010/Dec -  MSKCC  -  Non-IS  -  Gleevec  - 400 - 0.367%
2011/Mar -  MSKCC  -  Non-IS  -  Gleevec  - 400 - 0.0081%
2011/Jun -  MSKCC  -  Non-IS  -  Gleevec  - 400 - 0%
2011/Sep -  MSKCC  -  Non-IS  -  Gleevec  - 400 - 0.00084%
2011/Dec -  MSKCC  -  Non-IS  -  Gleevec  - 400 - 0%
2012/Mar -  MSKCC  -  Non-IS  -  Gleevec  - 400 - 0.004%
2012/Jun -  MSKCC  -  Non-IS  -  Gleevec  - 400 - 0%
2012/Sep -  MSKCC  -  Non-IS  -  Gleevec  - 400 - 0%
2012/Dec -  MSKCC  -  Non-IS  -  Sprycel  - 100 - 0%
2013/Jan -  Quest  -  IS  -  Sprycel  -  50-60-70  - 0%
2013/Mar -  Quest  -  IS  -  Sprycel  -  60-70  - 0%
2013/Apr -  CUMC  -  Non-IS  -  Sprycel  - 50 - 0.036%
2013/May -  CUMC  -  Non-IS  -  Sprycel  - 50 - 0.046%
2013/Jun -  Genoptix  -  IS  -  Sprycel  - 50 - 0.0239%
2013/Jul -  Genoptix  -  IS  -  Sprycel  - 70 - 0.0192%
2013/Jul -  Genoptix  -  IS  -  Sprycel  - 70 - 0.0034%
2013/Oct -  Genoptix  -  IS  -  Sprycel  - 70 - 0.0054%
2014/Jan -  Genoptix  -  IS  -  Sprycel  - 70 - 0.0093%
2014/Mar -  Genoptix  -  IS  -  Sprycel  - 100 - 0.013%
2014/Apr -  Genoptix  -  IS  -  Sprycel  - 100 - 0.0048%
2014/Jul -  Genoptix  -  IS  -  Sprycel  - 100 - 0%
2014/Nov -  Genoptix  -  IS  -  Sprycel  - 100 - 0.047%
2014/Dec -  Genoptix  -  IS  -  Sprycel  - 100 - 0%
2015/Mar -  Genoptix  -  IS  -  Sprycel  - 100 - 0%
2015/Jun -  Genoptix  -  IS  -  Sprycel  - 100 - 0%
2015/Sep -  Genoptix  -  IS  -  Sprycel  - 100 - 0%
2015/Dec -  Genoptix  -  IS  -  Sprycel  - 100 - 0%
2016/Mar -  Genoptix  -  IS  -  Sprycel  - 100 - 0.0228%
2016/Jun -  Genoptix  -  IS  -  Sprycel  - 100 - 0%
2016/Sep -  Genoptix  -  IS  -  Sprycel  - 100 - 0%
2016/Dec -  Genoptix  -  IS  -  Sprycel  - 100 - 0%
2017/Mar -  Genoptix  -  IS  -  Sprycel  - 100 - 0%
2017/Jun -  Genoptix  -  IS  -  Sprycel  - 100 - 0%
2017/Sep -  Genoptix  -  IS  -  Sprycel  - 100 - 0%
2017/Dec - Genoptix  -  IS  -  Sprycel  -  100 - 0%
 

 


#3 jamesm

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Posted 29 September 2011 - 10:16 AM

It doesn't. I was told the drug was moved from one category to the other. I'm on a top notch Aetna plan with a local government, so I would imagine anyone with Aetna needs to check into this ASAP. My annual out of pocket cost for Tasigna just went from $840 to $9600. I don't know how I'm going to afford this!



#4 Lizzybee

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Posted 29 September 2011 - 12:28 PM

I get my Tasigna from a cancer specialty pharmacy, and they help people apply for financial aid programs - is that possibility for you?

Also, ask your oncologist for a Novartis card that will get you 3 free months of Tasigna. I think you can get a new card once a year - so that would cut your annual cost by $2400.

Third, does your oncologist have a social worker?  If so, s/he may know of some financial aid programs.  If not, check with your nearest cancer center and see if you can have a consult with their social worker.

Good luck! I would also be in a panic if that happened to me!



#5 CallMeLucky

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Posted 29 September 2011 - 12:34 PM

I doubt it will be any different but you may want to check if they will cover Sprycel.  Chances are it is the same, but you never know.

Also check what they cover on Gleevec.  I know you switched to Tasigna because Gleevec wasn't getting you to zero, but if you are now at zero, it is possible Gleevec might keep you there and Gleevec may be a different tier.  That is a discussion to have with your doctor obviously.

It is tragic that we have to consider cost when making such important decisions about our health.

Good luck


Date  -  Lab  -  Scale  -  Drug  -  Dosage MG  - PCR
2010/Jul -  MSKCC  -  Non-IS  -  Gleevec  - 400 - 1.2%
2010/Oct -  MSKCC  -  Non-IS  -  Gleevec  - 400 - 0.25%
2010/Dec -  MSKCC  -  Non-IS  -  Gleevec  - 400 - 0.367%
2011/Mar -  MSKCC  -  Non-IS  -  Gleevec  - 400 - 0.0081%
2011/Jun -  MSKCC  -  Non-IS  -  Gleevec  - 400 - 0%
2011/Sep -  MSKCC  -  Non-IS  -  Gleevec  - 400 - 0.00084%
2011/Dec -  MSKCC  -  Non-IS  -  Gleevec  - 400 - 0%
2012/Mar -  MSKCC  -  Non-IS  -  Gleevec  - 400 - 0.004%
2012/Jun -  MSKCC  -  Non-IS  -  Gleevec  - 400 - 0%
2012/Sep -  MSKCC  -  Non-IS  -  Gleevec  - 400 - 0%
2012/Dec -  MSKCC  -  Non-IS  -  Sprycel  - 100 - 0%
2013/Jan -  Quest  -  IS  -  Sprycel  -  50-60-70  - 0%
2013/Mar -  Quest  -  IS  -  Sprycel  -  60-70  - 0%
2013/Apr -  CUMC  -  Non-IS  -  Sprycel  - 50 - 0.036%
2013/May -  CUMC  -  Non-IS  -  Sprycel  - 50 - 0.046%
2013/Jun -  Genoptix  -  IS  -  Sprycel  - 50 - 0.0239%
2013/Jul -  Genoptix  -  IS  -  Sprycel  - 70 - 0.0192%
2013/Jul -  Genoptix  -  IS  -  Sprycel  - 70 - 0.0034%
2013/Oct -  Genoptix  -  IS  -  Sprycel  - 70 - 0.0054%
2014/Jan -  Genoptix  -  IS  -  Sprycel  - 70 - 0.0093%
2014/Mar -  Genoptix  -  IS  -  Sprycel  - 100 - 0.013%
2014/Apr -  Genoptix  -  IS  -  Sprycel  - 100 - 0.0048%
2014/Jul -  Genoptix  -  IS  -  Sprycel  - 100 - 0%
2014/Nov -  Genoptix  -  IS  -  Sprycel  - 100 - 0.047%
2014/Dec -  Genoptix  -  IS  -  Sprycel  - 100 - 0%
2015/Mar -  Genoptix  -  IS  -  Sprycel  - 100 - 0%
2015/Jun -  Genoptix  -  IS  -  Sprycel  - 100 - 0%
2015/Sep -  Genoptix  -  IS  -  Sprycel  - 100 - 0%
2015/Dec -  Genoptix  -  IS  -  Sprycel  - 100 - 0%
2016/Mar -  Genoptix  -  IS  -  Sprycel  - 100 - 0.0228%
2016/Jun -  Genoptix  -  IS  -  Sprycel  - 100 - 0%
2016/Sep -  Genoptix  -  IS  -  Sprycel  - 100 - 0%
2016/Dec -  Genoptix  -  IS  -  Sprycel  - 100 - 0%
2017/Mar -  Genoptix  -  IS  -  Sprycel  - 100 - 0%
2017/Jun -  Genoptix  -  IS  -  Sprycel  - 100 - 0%
2017/Sep -  Genoptix  -  IS  -  Sprycel  - 100 - 0%
2017/Dec - Genoptix  -  IS  -  Sprycel  -  100 - 0%
 

 


#6 jenz

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Posted 29 September 2011 - 01:18 PM

I have Aetna and I just got my monthly Tasigna back on 9/15/11 and my copay was the standard $65.  You said the change was effective 9/1/11? Or did you mean it is coming 10/1/11?



#7 jenz

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Posted 29 September 2011 - 01:32 PM

I just called and discussed with Aetna, and the way my policy is with them is at the highest tier known as 'brand' I pay a flat $65 copay.  For you it sounds like you went from one tier that was just copay maxium to a new tier which requires the 10% cost.  This is my second year with Aetna and during my first year I was in your boat, my Gleevec I was responsible for 20% which resorted to about $900 a month.



#8 CallMeLucky

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Posted 29 September 2011 - 01:41 PM

Keep in mind that in many cases, individuals are not actually insured by Aetna.  Aetna is a network and administrator for many self funded plans.  So plans can vary and still carry the Aetna name.  Also different policies have different coverage's.  Just like any other insurance, for example, we can both have Geico but you can have full coverage and I can carry the minimum liability amount.  If we both crash our cars, you are covered for repairs, I am not.  So you really have to understand the policy provisions when something changes.  What is interesting here is the idea that the drug was re-classed to a different tier.  That could potentially effect multiple policies if the company says across the board, this particular drug now belongs in a different tier.  Might be worth exploring what prompted them to change it and then find out if they had the right to do it.

Some other things to look at is if this is an actual policy or if it is a group plan.  If it is a group plan then you may consider discussing with your employer, but that can be a delicate situation.  If it is in fact an insurance plan, then find out what state the policy was underwritten in and check if the state has a chemo parity law.  If it does, then you could push to have the drug covered under your major medical, instead of under the prescription plan.


Date  -  Lab  -  Scale  -  Drug  -  Dosage MG  - PCR
2010/Jul -  MSKCC  -  Non-IS  -  Gleevec  - 400 - 1.2%
2010/Oct -  MSKCC  -  Non-IS  -  Gleevec  - 400 - 0.25%
2010/Dec -  MSKCC  -  Non-IS  -  Gleevec  - 400 - 0.367%
2011/Mar -  MSKCC  -  Non-IS  -  Gleevec  - 400 - 0.0081%
2011/Jun -  MSKCC  -  Non-IS  -  Gleevec  - 400 - 0%
2011/Sep -  MSKCC  -  Non-IS  -  Gleevec  - 400 - 0.00084%
2011/Dec -  MSKCC  -  Non-IS  -  Gleevec  - 400 - 0%
2012/Mar -  MSKCC  -  Non-IS  -  Gleevec  - 400 - 0.004%
2012/Jun -  MSKCC  -  Non-IS  -  Gleevec  - 400 - 0%
2012/Sep -  MSKCC  -  Non-IS  -  Gleevec  - 400 - 0%
2012/Dec -  MSKCC  -  Non-IS  -  Sprycel  - 100 - 0%
2013/Jan -  Quest  -  IS  -  Sprycel  -  50-60-70  - 0%
2013/Mar -  Quest  -  IS  -  Sprycel  -  60-70  - 0%
2013/Apr -  CUMC  -  Non-IS  -  Sprycel  - 50 - 0.036%
2013/May -  CUMC  -  Non-IS  -  Sprycel  - 50 - 0.046%
2013/Jun -  Genoptix  -  IS  -  Sprycel  - 50 - 0.0239%
2013/Jul -  Genoptix  -  IS  -  Sprycel  - 70 - 0.0192%
2013/Jul -  Genoptix  -  IS  -  Sprycel  - 70 - 0.0034%
2013/Oct -  Genoptix  -  IS  -  Sprycel  - 70 - 0.0054%
2014/Jan -  Genoptix  -  IS  -  Sprycel  - 70 - 0.0093%
2014/Mar -  Genoptix  -  IS  -  Sprycel  - 100 - 0.013%
2014/Apr -  Genoptix  -  IS  -  Sprycel  - 100 - 0.0048%
2014/Jul -  Genoptix  -  IS  -  Sprycel  - 100 - 0%
2014/Nov -  Genoptix  -  IS  -  Sprycel  - 100 - 0.047%
2014/Dec -  Genoptix  -  IS  -  Sprycel  - 100 - 0%
2015/Mar -  Genoptix  -  IS  -  Sprycel  - 100 - 0%
2015/Jun -  Genoptix  -  IS  -  Sprycel  - 100 - 0%
2015/Sep -  Genoptix  -  IS  -  Sprycel  - 100 - 0%
2015/Dec -  Genoptix  -  IS  -  Sprycel  - 100 - 0%
2016/Mar -  Genoptix  -  IS  -  Sprycel  - 100 - 0.0228%
2016/Jun -  Genoptix  -  IS  -  Sprycel  - 100 - 0%
2016/Sep -  Genoptix  -  IS  -  Sprycel  - 100 - 0%
2016/Dec -  Genoptix  -  IS  -  Sprycel  - 100 - 0%
2017/Mar -  Genoptix  -  IS  -  Sprycel  - 100 - 0%
2017/Jun -  Genoptix  -  IS  -  Sprycel  - 100 - 0%
2017/Sep -  Genoptix  -  IS  -  Sprycel  - 100 - 0%
2017/Dec - Genoptix  -  IS  -  Sprycel  -  100 - 0%
 

 


#9 Happycat

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Posted 29 September 2011 - 06:36 PM

I think the tier system is typically referred to as the drug formulary for the particular policy you are in.

When I have seen drugs move from a lower copay tier to a higher one, it usually means there is a "preferred brand" they would rather have you take.  They did this years ago when Claritin went OTC.  Suddenly, my Zyrtec, which was NOT OTC yet, doubled in copay.   They were trying to drive patients to choose the OTC Claritin.  Of course, the generic houses hadn't started getting Claritin on the shelf yet, so everyone had to pay the full OTC price for the namebrand Claritin.  I had to stick with the more expensive Zyrtec, because it worked for me when Claritin did not.

I saw the same thing happen when the proton-pump inhibitors for acid reflux first started to go OTC.  One went OTC first, so the other Rx ones switched to Tier 2 or Tier 3.  

However, this really doesn't make any sense for Tasigna, since there is no OTC TKI.  Call the insurance company and ask if there is a "preferred" brand.  It might be they are trying to drive people to take Gleevec, in preparation for its eventual OTC debut.  If that's the case, I'd ask if your oncologist can show it is medically necessary for you to be on Tasigna (because you failed Gleevec or found it intolerable), then could you get it covered under the Tier 1 copay.   Ask them to provide you a copy of the formulary, too.  I think they have to do that.

I'd also let your HR benefits people know about it.  I'm sure the insurers offer employers a range of formularies to choose from, and they simply pick one based on overall cost.  They won't know the formulary has serious deficiencies if you don't tell them about it.    

HTH,

Traci



#10 mjbayes

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Posted 03 October 2011 - 09:59 PM

I also have Aetna.  I have had the Aetna plan for over 4 years.  my copay is $65.00 per month but not until the full deductible has been paid, 2500.00 in my case.   Also if you have a coinsurance you could have to pay the 10% (on 90/10 coinsurance plans). ( in my case up to 5000.00

Yes, I did see that this is considered a higher tier drug.  At one point they were telling me I could only get Tasigna from the Aetna Specialty pharmacy but they changed that when they were unable to get the drug when I needed it and I would have been with out it for who knows how long.

The end of the year is coming and the new drug formularies are starting to be announced along with any across the board changes in plans.  I always dread this because it most likely means less coverage and more cost. I already pay 543.00 per month for my aetna insurance.  I can certainly not afford higher rates but fully expect that the cost will go up.



#11 Cathy

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Posted 04 October 2011 - 07:24 AM

I am also on Aetna, and just got our shot version of changes to benefits so I'm not 100% yet. but from what I read my co pay will go from $100 a month to $225.00 a month and my employer won't authorize 90 day supply so it would be cheaper for me. My friends say they are hoping you'll die and they won't have to pay for 3 months! bad humor. It's really going to strap me more. Health care is a real problem when you are seriously sick.

Cathy 


Cathy

 

DX 5-2010  Started normal hydra then Gleevec for 9 months stopped working

Tasigna after 5 pills pancreatis  numbers jumped up quickly

Started Sprycel 100, 8-2010  for a 3 years went down to 50 mg numbers at one point really jumped up quickly

currently on 70 mg for last 2-3 years trying to get onc to reduce dose Numbers never stabilize never MMR till 4-2017 bearly and jump up and down in and out of MMR stayed MMR for 3 months then

After 6 years on sprycel fluid on both lungs, drained still have some fluid on lungs, and currently off drug 4 months now

numbers lower then ever go figure I've never been this low of a number 

last 2 tests .0686 and .0181 !!

 


#12 jamesm

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Posted 04 October 2011 - 07:34 AM

After back and forth back and forth, it is sounding like my employer made a small tweak to the group insurance policy that should not have impacted my copay or the classification of Tasigna at all. I've been told that this is all likely a "computer glitch" and Aetna is in the process of clearing it up. Thankfully, they sent me a 30 day supply under the standard copay. I'm sorry if I alarmed any Aetna people out there.

What's really sad and scary is that I talked to 2 different people at Aetna and they confidently told me that Tasigna was reclassified and that $800 was the new copay. Got to love the medical industry.

Thanks to all who responded. I really appreciate the help.

James






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