Medicare D says they won't cover capecitabine

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caall1234
caall1234 Member Posts: 214
edited July 2017 in Stage IV/Metastatic Breast Cancer ONLY

Has anyone else had this problem? I am suppose to start

this new med soon. But got a letter that they won;t cover it.

What happens now?

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  • proudtospin
    proudtospin Member Posts: 5,972
    edited July 2017

    i got that as well, my doc switched me to,taxol but if time allows, you could appeal, dumb as they were fine with the infusion

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  • caall1234
    caall1234 Member Posts: 214
    edited July 2017

    How is that drug doing? And do you have side effects with it. I was on afinitor but it quite working

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  • proudtospin
    proudtospin Member Posts: 5,972
    edited July 2017

    i did 3 months of affinitor and progressed and never worked

    I have weekly infusions of the taxel, hair thinning and think i have foot hand thing as feet feel awful

    Only done 2 weeks so,do not know how it is working yet

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  • 50sgirl
    50sgirl Member Posts: 2,527
    edited July 2017

    Wow, Caall, I have to say that I was surprised to hear this since so many people have taken that drug. I had assumed that it would be my next treatment when my current one fails. I looked up the coverage in my Med D plan, and sure enough it is not routinely covered. It has a "Step Therapy" footnote, meaning that some other less expensive drug should be tried first. If that (unnamed in footnote) drug has been tried or the dr feels that it would not be effective, the dr can contact them, and my Med D plan might cover There may be effective, lower-cost drugs that treat the same medical condition as this drug. You may be required to try one or more of these other drugs before the plan will cover your drug. If you have already tried other drugs or your doctor thinks they are not right for you, you and your doctor can ask the plan to cover capecitabine. Jeez, they don't make things easy, do they.

    I hope you get things straightened out soon.


    Lynne

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  • caall1234
    caall1234 Member Posts: 214
    edited July 2017

    I was of affinitor and it cost 13,000.00 a month. This drug is about 2,000.0 I think I read that maybe

    Medicare B will cover it. So will have to see what happens. So far this year my med bill in over

    80,000.00 so the cost for this is alot less

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  • Husband11
    Husband11 Member Posts: 2,264
    edited July 2017

    If you have to pay out of pocket, I would consider a trusted generic version of capecitabine.

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  • caall1234
    caall1234 Member Posts: 214
    edited July 2017

    I read online that Medicare B will cover this drug that D will not. So will see if B will

    cover it.

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  • proudtospin
    proudtospin Member Posts: 5,972
    edited July 2017

    let me know f you get coverage, then again, i am already well into the taxol stuff

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  • caall1234
    caall1234 Member Posts: 214
    edited July 2017

    I just got a call about my med and I do not have to pay anything I guess Medicare B is

    paying for it

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  • proudtospin
    proudtospin Member Posts: 5,972
    edited July 2017

    wow that is great, best of luck

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