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Old Mon May 12, 2008, 07:26 PM
tasmith tasmith is offline
Join Date: Oct 2006
Posts: 9
will medicare pay

Hi Folks,Question ,will Medicare pay for ,Exjade,Revlimid,and Aranesp.these are all costly med,s that I currently take.I will be switching to Medicare from Va care.But would like to know if anyone has answer.Current Myelofibrosis is really making me tired.Transfusions about every 5 to 7 weeks.Aranesp 200 mg every week .Thank you..T.smith
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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.
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Old Tue May 13, 2008, 09:03 AM
knstone knstone is offline
Join Date: Aug 2006
Location: Cincinnati, OH
Posts: 118
Medicare for drugs

My experience with Medicare part D is that I pay the $4050 "out of pocket" and then pay 5% of the cost after that. For Revlimid, currently costing $8370.06/month for 10 mg caps my first months cost was $4088. Each month after the cost is at 5% or $399.57.

My retirement medical insurance switched to Medicare part D in 2008, administered by Aetna. This seems to be a trend among companies to reduce their costs for medical for retirees.

If one is on an in-clinic medication then Medicare part B covers nearly all of this. Thus Vidaza which is even higher in cost than Revlimid would be covered in the clinic and one would pay very little for it.

The oral meds are really nice to take, but clearly it costs a lot more on Medicare.

Since Vidaza is in trials for an oral version I wonder how successful it will be if ones costs are so much more for out of clinic meds.

It's ironic that the cost to administer Vidaza plus the clinic costs would be far greater for Medicare part B than an oral version would be yet the patient will pay a very large monthly cost for the oral version.
Kirby71, RAEB2 dx 2/04, Thalidomide 30 mo, Revlimid 18 mo, No resp Vidaza
6/09 2nd Thalid use, Promacta, Lowdose Dacogen added 10/09 at 40% blasts. 5/11 BMB-blasts 8%.
2/11 2nd Revl restart=good resp, Platelets drop 6/11, 3rd Thalid,+Nplate+Dacogen. 7/12 Cnts stable for 10 mo.
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Old Tue May 13, 2008, 11:28 AM
Eileen Eileen is offline
Join Date: Nov 2007
Location: FL
Posts: 47
Smile medicare

Hi everyone,
I`m on vidaza IV ,procrit when needed & neuprogen when needed,Medicare part b pays for all .when i had vidaza in the stomach they paid for it but i had to pay for anti nausea meds,part D paid for some but like most of you I`m long since in the donut hole because of many other meds for differant heath issues as well.What a mess.
Hope this helps some,
Eileen.72,dxMDS 2007.currently on vidaza,procrit & neuprogen.
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