will medicare pay

[tasmith]

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

[Steve Kessler]

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

[knstone]

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.

[Eileen]

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
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