MEDICARE PLAN D INS. OPTIONS FOR BC & METS DRUGS

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Anonymous
Anonymous Member Posts: 1,376
edited February 2019 in Employment, Insurance, and Other Financial Issues
MEDICARE PLAN D INS. OPTIONS FOR BC & METS DRUGS
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  • marijen
    marijen Member Posts: 3,731
    edited November 2015

    Hi Everyone!

    It's OPEN ENROLLMENT time for MEDICARE PRESCRIPTION DRUG POLICIES. November 1 to December 7). I would like this topic to be a place where we can talk about the different drug plans available, the COST OF DRUGS FOR ALL STAGES OF BREAST CANCER AND METS (metastatic bone, liver, brain, lung, heart, other) and the frequency of which they are prescribed. Currently I have Silverscript Choice Plan D insurance. I am thinking about changing to AARP United Healthcare Medicare Preferred RX because I am concerned being Stage IIIA that there will be more expensive drugs needed. We can include financial aid options for drugs as well.

    For instance my Silverscript is $25.80 per month, AARP Medicare Preferred RX is 58.80 per month. However, MPRX has set rates for tier three of $35 or $45 instead of the Silverscript percentage option which is 40% or 50% depending on the pharmacy. Tier 4 and 5 are the same percentage for both polices (2015) rates. The problem is the policies don't cover the same drugs, nor can we see the future. I see Ibrance is very expensive? I was given a nausea prescription yesterday for after surgery. Silverscript does not cover and there is a generic that the Safeway price is $41 for 12 pills, Rite Aid is $80 for 12 pills. But MPRX is 3.61 for 12 pills. Thing is I don't know if I'm going to like this drug or really need it... So just an example.

    It's not fair that unwell people have to deal with all this, but spending less is the name of the game.

    Any comments, corrections, suggestions, or experience anyone?

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  • SpecialK
    SpecialK Member Posts: 16,486
    edited October 2015

    It is important to differentiate between drugs that are given by infusion (many chemotherapy drugs), oral drugs given in place of infused drugs (some chemo drugs, and some for treating side effects of chemo like usually infused anti-nausea drugs), and oral drugs to treat collateral side effects and hormonal therapy.  Medicare covers them differently, in that infused drugs, and oral drugs that take the place of infused drugs, given in a doctor's office or treatment center, are covered under Part B of Medicare as medical treatment, while oral drugs for some side effects and hormonal therapy would be covered by Medicare Part D - as regularly prescribed medications.  I do not have Medicare, but my insurance handles this the exact same way, and I believe that is consistent with most insurance coverage also.

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  • marijen
    marijen Member Posts: 3,731
    edited February 2019

    Yes SpecialK, I get reclast by infusion and it's covered by Medicare Part B. I told the broker this choosing a plan when you don't know what drugs the doctor may be giving you in the future, is not fair, not right. Why should we have to guess? I do think it's be better to have an upgrade, pay a little bit more, and maybe retrieve that little bit when a drug I am prescribed is not covered by the first cheaper plan. It's a guessing game at the wrong time. I could already be better from my surgery or not. Have to wait for the pathology report. On the other hand I could get what I think is a better plan but it doesn't cover a special drug I might need in the next year. How are you doing. Are you still on anything. Whoa 12 surgeries. What was that about?

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  • SpecialK
    SpecialK Member Posts: 16,486
    edited October 2015

    marijen - I am doing fine - I am on Femara for at least another year - covered by my regular insurance prescription drug coverage with a monthly $5 co-pay.  I also get a Prolia injection at my oncology office every six months - covered by the medical treatment portion, as is your Reclast.  This drug is given by my MO due to bone density issues from Femara.  My surgery saga is due to reconstruction issues, but I did require a separate ALND surgery after my BMX because my SNB in the operating room was declared clear, but turned out not to be in the lab later.  Because I am Her2+ both my breast surgeon and oncologist insisted that I remove the rest of the nodes in levels 1&2 in a separate surgery.  Good thing as I had a much larger node further up that had not been detected on exam or by imaging.  I have had 14 surgeries so far, the BMX, ALND, then 12 more, and I will have at least two more, minimum.  I am the exception, not the rule though, so don't let my story make you worried!

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  • artistatheart
    artistatheart Member Posts: 2,176
    edited November 2015

    Marijen, my Ibrance costs a whopping $6450.00 per month which thankfully my insurance pays all but $10.00.....for now. They have approved it for one year but who knows how long it will work for me. I've been on it for 2 1/2 months.

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