Medicare coverage of Vidaza

[Lee Rhinehart]

I have been on Vidaza for 4 cycles and it appears to be helping. Just went on Medicare 11/1/17 and the pharmacy called to say that Medicare will not cover the drug! Empire Blue Cross/Blue Shield did and I had no copay as it was run through the medical portion of my insurance and not the drug component. I was informed yesterday that since Medicare will not cover my Vidaza, which is given in the doctors’s office, and it has to be run through my Medicare D insurer, my copay will be $1600.00 a month!
Has anyone had any success having Medicare B cover this since it is done in a doctor’s office under her supervision? What steps do I need to take to make this happen? Thank you

[Sharon Hains]

Do you have a Medicare Advantage plan with part D coverage, or regular medicare? I have regular medicare and pay for AARP’s supplement plan F, plus the least expensive Part D plan. All my medications are given in a medical setting, and they are paid for, but if my hgb levels get to a certain point, the payments will stop until my levels drop. If you have a Medicare Advantage plan, you may want to change to regular medicare and add the supplements. If plan F is not available, then plan G is the next best plan, and requires payment of the annual part B deductible. I don’t know what state you live in, or your personal financial or medical situation, but I have had medicare and the supplement since 2015 and the only cost I have are for the supplement, Part D plan and monthly medications, which are generic. It is way less expensive for me, especially since the Aranesp shots I get are $2000 each, and I get a shot every 2 weeks. Of course, every situation is different, and if you have a lot of prescriptions, or can’t afford the supplement, it can be complicated. I would contact a medicare specialist in your area and go over the plans and see what works better for you financially. I’m not sure why the medication is being billed through the prescription plan, but if you have a medicare advantage plan with prescription coverage, that may be the way it is done. Good luck to you, and come back to me with any questions at my personal email calgal50@icloud.com.

[Joyce Besase]

Lee, I have MISS (agreeive). I’m just finishing my 10th cycle. I’m doing fine so far. I have Medicare/advantage plan. I get 128mg of Vidaza about every month. This is for a week (7) days off 21 days and back on again. Everytime I get the shot I pay 21.80. I go to the Florida Cancer Specialist. Maybe you need to go to a cancer center or hospital for treatments so it’s paid.

[Donald Williamson]

Hey Lee, I agree with Sharon that the best plan as per your requirement I feel is Medicare plan F or plan G. Plan G provides basic benefit, skilled nursing facility, Medicare part A deductible for hospitalization and Medicare part B excess charges. If your requirement is of more then you can even go for Medigap. Medigap plan F high deductible will surely fulfil your requirement. You can search for Agencies providing these plans in your state. You will easily get one.

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