View Single Post
Old Tue May 13, 2008, 01:52 AM
Steve Kessler Steve Kessler is offline
Join Date: Aug 2006
Location: Bellevue, WA
Posts: 71
Wink Medicare coverage

My experience is yes and no. First, you have to shell out the deductible and pay copays on meds until you and plan have paid $2510. Then, you have to pay 100% of "Tier 4" drugs until you have paid out another $4050 (the doughnut hole). Now that you're out about $6,000, you're into the catastrophic coverage. You pay 5%, the plan pays 95%.

Take Exjade, for example. Retail for 1500mg (my monthly dose based on body surface) is about $15,000. Medicare reduces the cost to about $4600. Thus, once you've paid the first $6,000, your cost per month will be $230. Still very expensive, but not a backbreaker for most people. Revlimid is also covered in similar fashion. Good news is there's only one doughnut hole, not a separate one for each drug.

Before you switch to any other plan, make sure the drug is included in the formulary for the insurance company.

Epo or Aranesp... some regions of the country, they are covered. Other areas, eg the Pacific Northwest, they are not. Big battle going on between oncologists and Medicare.

Hope this helps.

Steve Kessler
Steve Kessler,Age 71, Dx 3/2001, Currently AML converted from MDS, 5q-, 11q23, Negative response to Aranesp, Revlimid. Partial response to Vidaza in the past. On a study using ON1910.NA, counts too low to go to Stanford on schedule.
Reply With Quote