Best Ins companies for covering drug cost

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• July 3, 2006 at 7:53 pm #13747
  chuckk333

  Member

  I am newly diagnosed for suspected MDS and have just had a Bone marrow withdrawal for biopsy. What I read on this forum about the cost of drug therapies boggles my mind. I have just changed to an Medicare Advantage plan with Humana that includes the Part D drug coverage. The drugs shown on this forum are not in their formulary. I have not received the test reaults from the BMB. I read here that come patients are having copays that are affordable, but the thousands per month? wow.

  July 3, 2006 at 10:09 pm #13748
  Rackon

  Member

  Please don’t panic.

  Many drugs are (or can be) approved that don’t appear on the formularies. Depending on the insurer, deductibles vary. But most anti-cancer drugs are covered, even the so called “orphan” drugs. Many drugs commonly used to treat MDS such as Procrit and Aranesp are covered.

  Just be aware of the Medicare Part D “doughnut hole” in prescription coverage – it can be a bit of a shock if you’re on a very expensive therapy like Revlimid. But Part D will still be a great benefit once you’re through the doughnut hole. (You can read about it here on the homepage of this site.) Part D covers (with copays) up to $2600 of prescription drugs, then you are responsible for the next $2600, after which, Part D pays 95% of your prescription drugs.

  Should your doctor prescribe a rare or expensive drug for your MDS, the drug companies and specialist pharmacies have people on staff who do nothing but work with the insurance companies to get these drugs paid for. For people with financial needs, many drug companies have assistance programs.

  Just as an example, Part D pays for my Dad’s Revlimid, which costs $7000 a month. Dad had no deductible on his AARP plan. We ended op paying nearly $3600 for the first month – ouch – but now we’re through the “doughnut hole” so Part D pays all but $350 per month of his Revlimid.

  My suggestion is to wait and see IF you have MDS before you research which drugs are covered. I know this disease can be very scary and confusing but please don’t hesitate to ask your doctor questions. There are many types of MDS and people respond very differently to the disease. Your doc may not start you on anything very dramatic yet. But if he does, it’ll probably be covered in some fashion.

  Also feel free to post questions folks here.

  July 3, 2006 at 10:28 pm #13749
  Suzanne

  Member

  Humana turned out to be the best carrier for me and I put in every drug I ever had during the treatment in and out of the hospital.I had pretty much decided if I was having much treatment to pay the higher fee so that I did not have the donut hole exposure but by the time it went into effect I was not taking enough to do that. Everything was there under one classification or another. Of course Revlimid was not approved when I applied so I did not check for any of the drugs that would come under chemo-or trial drugs knowing that they would not be there. Things have changed but from what I am reading here most insured people are getting coverage.

  July 4, 2006 at 2:29 am #13750
  Neil

  Member

  Hi Chuck,
  Age is a factor. If you are on medicare, Part B will cover drugs such as Procrit, Aranesp, Neupogen and some other drugs as long as they are administered in the docs office. A supplemental will pick up what mediacre does not.
  Your doc or someone in his/her office specializing in insurance issues can provide you with the info.

  July 6, 2006 at 2:21 am #13751
  Terri

  Member

  Bob Gets Vidaza and Procrit, Not sure how the Drugs would be covered by a Prescription plan but since all shots are administered in the Doctors office we have not had a problem with them covering the drug, we have Aetna Open Access HMO.
  I have a $50 copay per week but compared to the cost, so far since Jan Ins has paid close to $80,000 and that does not include Bob’s recent Hospitalization.
  I know some people were self administering their Vidaza and I think then it would fall under the prescription part and not the actual Health Insurance coverage.

  July 7, 2006 at 2:44 am #13752
  chuckk333

  Member

  Thanks for your input. I was asking so that if I need to change ins. companies, I could do so before my test results are back. My Humana ins is what is called Medicare Advantage and is in lieu of medicare. Humana gets my medicare premium from medicare and then pays the providers. Medicare part D is a part of the plan, but the drugs that appear here are not covered, according to their formulary.

  July 7, 2006 at 4:47 pm #13753
  covergirl

  Member

  I have Anthem Blue Cross & Blue Shield thru my job. They have been wonderful and very helpful.

  They did initially reject my ATG treatment last year, however, when my doctor appealed, they changed their mind. Since that time they have paid everything with just my co-pays, which I seem to payout around mid-year, then they pay 100%. From $5000 for Exjade to txs, bmb,and HLA typing. Since my employer pays for my insurance as well, I know I have been blessed.

  July 7, 2006 at 5:33 pm #13754
  franm

  Member

  Hi Chuck:

  Sorry to hear that you might hve MDS.

  My husband is 74 years old and was told, by blood test that he had MDS over a year ago. I think it was in 04. He was on a HMO at the time and his primary care doc. told him to get off that and go for a Medicare plus plan. So, now he is on Medicare plus AARP. It takes a long time for them to pay, since he got off the HMO in October of last year. They are finally paying now. It is not a cheap plan. It cost him over 200.00 a month for AARP, which is United Health and he also has Humana for prescription drugs.

  It seems when you are on Medicare you have to be ready for anything.

  Jim is starting on his 2nd treatment of Vidaza today for 7 days and then he will have 3 weeks off. I hope it doesn’t lower his white cells to much. He has been in the hospital for infections and last time it was a blood clot, so now he is on Coumaden and chemo.

  We are taking one day at a time.

  We wish you the best of luck.

  Fran

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