Cost of hormone treatment for BC.. Is it worth it?

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JOANWILL55
JOANWILL55 Member Posts: 10
edited August 2016 in Hormonal Therapy - Before, During, and After

I plan to retire in two years. Unfortunately, I have just been diagnosed with BC and already had a lumpectomy. My treatment plan is chemo, followed by radiation and Herceptin - altogether, one year. Then 5 years' endocrine pills.

My oncologist said the one year treatment will reduce the chance of recurrence from 30% to 15%. And the five years' endocrine pills will reduce the chance of recurrence rate to 7.5%.

I heard that the endocrine can cost thousands dollars. Does anyone know how much Medicare Part D will cover? How many elderly are taking the endocrine for five years? Is it worth it given the financial burden and the side effects. I heard that these endocrine are pills 'hard to swallow' and 25% of users stopped after the first year.

Thanks.


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  • Luna52
    Luna52 Member Posts: 147
    edited August 2016

    Joan,

    I am in a similar situation. I'm taking early retirement in November and staying on employer's health plan until I turn 65 in Sept 2017. I've been doing a lot of Medicare supplemental (gap) and drug plan research mainly for my husband as he has been covered by my employer and needs to switch to Medicare by November. Like you, I have been the picture of health until my recent BC diagnosis. Sooo, I have gone back and looked at some of the plans with my potential meds now in mind.

    Medicare D is confusing as there are many prescription drug plans. You don't just buy Medicare Part D like you buy Part B. There are different options/prices depending upon where you live, whether or not you want an annual deductible, and what drugs you take. When the time comes, you'll want to explore that with your current drug list in hand.

    But, for sake of general planning, I am looking at the Silverscript Choice plan which is offered by CVS/Caremark. It costs $25 per month and has no annual deductible. My oncologist gave me literature on Femara (generic name Letrozole) and Arimidex (generic name Anastrozole). Neither of the trade names are covered but both of the generic drugs are covered. Letrozole is classified by Silverscript as a Tier 3 drug. Lowest cost is CVS mail order 90 day supply for $102. Anastrozole is classified by Silverscript as a Tier 2 drug. Lowest cost is CVS mail order 90 day supply for $32. When the time comes and if I am on one of these drugs, I would do more shopping around for the best plan given my actual prescription. Each plan has their own formula for classifying and pricing.

    You can change your Medicare Part D plan annually as your needs change. They can't reject you regardless of your medications.

    Having said all that, you have plenty of time to see how you react to whatever drug your doctor recommends while you are still covered by your current health plan. Like you, I have been reading a lot about side effects.

    Wishing you all the best! It can be so overwhelming especially going from taking no prescription meds to a 5+ year regimen.

    Luna52




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  • Denise-G
    Denise-G Member Posts: 1,777
    edited August 2016

    I have no prescription coverage, but Anastrozole (Arimidex) is very inexpensive.  I pay $27.00 for 3 month supply.  Also, ALWAYS check drug prices at Costco.  You do not have to be a member.  And also www.goodrx.com  to find drug prices in USA.

    Aromatase Inhibitor drugs cut recurrence risks by 50%.  That is worth any side effects I've had.  I'm a huge advocate for women to at least try these drugs ESPECIALLY when you are Her2 Positive.

    Best of luck


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  • Meow13
    Meow13 Member Posts: 4,859
    edited August 2016

    I paid less than 5 dollars a month 3.something because i was taking the generic and my medical plan is pretty good.

    I was on anastrozole and switched to exemestane, total time I endured about 3.5 to 4 years.

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  • JOANWILL55
    JOANWILL55 Member Posts: 10
    edited August 2016

    Many thanks for the responses. Now I can breath easier. $100 or $200 a month is much better than what I heard - thousands dollars a month.

    If it's $1000 a month, that is almost the amount of rent. Most senior would not be able to afford. Even for a couple who can make $6 a mouth - thus probably do not meet the requirement of poverty - $1k is a SIGNIFICANT portion of their income. Good thing is that supposedly I only need to take it for 5 years. Not a life time.

    By the way, can we get drugs from oversea? Is it legal? Is it ethical? I heard that the pharma's charge the Americans at a higher rate.


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  • ChiSandy
    ChiSandy Member Posts: 12,133
    edited August 2016

    I pay $30/mo for letrozole at a preferred pharmacy in my Part D plan. Under my United regular insurance (deliberately filled the Rx the day before going on Meducare) it was $9. And my Part D doesn't even cover it, but it's cheap enough. If you can manage $200/mo, 90 days of brand name Femara (NovartisUK--the American or Canadian Novartis costs a bit more) ran me $588 at Canadadrugs.com, vs. $2100 at Costco and $2700 at CVS. I went with Humana Enhanced rather than Silverscript or BCBS because my agent said Humana had the largest formulary, and Silverscript ties you to CVS, where you can't specify a particular generic mfr (same problem as with my old OptumRx mail order)---you have to take what they stock, and have the right to switch suppliers midstream with no notice or recourse. But my neighborhood indie orders me the Roxane or Teva generics. Roxane is cheap, has the fewest additives and least side effects, better even than Femara itself, but people are catching on and it's getting scarcer; Teva is almost as tolerable as Femara, and has the shortest inactive-ingredient list of any version except Novartis Femara and Rixane letrozole. A lot of women have problems with Sun and Accord. Be thankful Mylan doesn't make it--Lordknows how high they'd jack the price up.

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  • octogirl
    octogirl Member Posts: 2,804
    edited August 2016

    Several people have addressed your concern about the cost of AIs, I think, but I will just jump in to add that while some women find the side effects to be hard to swallow, I don't think the same can be said for the actual pill. I was first on Arimidex, which did give me a fair amount of side effects. I've since switched to a generic version of femara (letrozole) and it is quite tolerable in terms of side effects, even over the long term. As for swallowing the pill: in the case of the pill itself with both drugs the actual pill is quite tiny. Unless you mean figuratively, swallowing it should not be a concern at all.

    Edited to add: Ok, my vision is bad before I have coffee in the am: just realized that you put 'hard to swallow' in quotes, so you did mean figuratively. Sorry about that, but I will leave the post in case others are concerned, and to reinforce that you shouldn't assume the side effects won't be tolerable until you try it, especially since cost is much less than you feared. (I am lucky enough to have good insurance and only pay about $5 a month...)

    Octogirl

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  • pupmom
    pupmom Member Posts: 5,068
    edited August 2016

    Not dying of breast cancer is well worth it, imho. Also, not everybody has serious se's. Rolling the dice when the house has heavily rigged the results is not a great option.

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  • Claire_in_Seattle
    Claire_in_Seattle Member Posts: 4,570
    edited August 2016

    I spent something like $700 for the entire FIVE YEARS of anastrazole. The key is to start with generics, and now that is fortunately an option. I still would have done the therapy if it had required the $129 per month which was the case prior to it going to generic. Fortunately, only a couple of months of paying the $129 prior to this happening. I was over the moon when the monthly co-pay went to $10. It was even less later on.

    This should not be a financial burden. AIs are one of the miracle drugs in creating survivors as is Herceptin.

    We are just so fortunate to have these options available. Good luck with the rest of active treatment, and good luck with your time doing AIs. For what it's worth, you should expect to live a normal life, and also make sure you get a lot of exercise (which you should be doing anyway for a host of other reasons). - Claire

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  • Luna52
    Luna52 Member Posts: 147
    edited August 2016

    ChiSandy,

    Thanks for the detailed info about generics and why you chose Humana Enhanced. I will miss my employee United coverage went I enter the Medicare world of so many choices.

    A bit off topic, but what Medicare Supplemental Plan do you have? In addition to the drugs, all the follow-up care adds up. You sound like you have really researched your options.

    Luna52

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  • Jennie93
    Jennie93 Member Posts: 1,018
    edited August 2016

    Can't imagine who told you it's expensive. Seriously. Maybe back when there was no generic??

    A quick check on GoodRx shows that tamoxifen averages about $20/mo., anastrazole about $10, letrozole about $15, and exemestane about $200. And all those prices are with no insurance coverage at all. Most people have at least some prescription coverage.



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  • Meow13
    Meow13 Member Posts: 4,859
    edited August 2016

    exemestane was $3 a month or something like that, the generic. I think AI drugs are proving to be even more effective than once thought. I saw others with oncodx reports where the mo has crossed out the risk of recurrence and put in a bit better odds with AI drug. I would atleast try it unless you have a health concern. Discuss with an oncologist.

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