Medicare Part D and Revlimid

[Dawn]

I am trying to sign my dad up for a Part D plan with Medicare but I need to know which insurance company is paying for Revlimid, when I do a formulary check it cannot find this medication.
RevAssist was not able to tell me this info either, apparantly Part D pays or helps with the cost?…Please help! Thanks! I am in Washington State if that makes any difference.

[Neil]

Hi Dawn,
If a drug is not on the formulary it will depend upon which Insurance co he selects for part D. Since Revlimid is not on any formularly the insurance co. probably has a co-pay associated with non-formularly drugs. The amount of the co-pay varies from company to company and plan to plan.
BUT and this is a big BUT— It is possible Revlimid will be covered under Medicare Part B if it is given to him by a technician in a docs office. Not entirely sure, but it may fall into the same class of drugs that Procrit and Aranesp are in. Best bet is to ask the docs insurance guru how it will be handled. If they indicate Revlimid will be covered by medicare and a supplemental, you might want to get it in writing.
Another way to find out is to go to
http://WWW.medicare.gov.
plug in his social security # and answer the rest of the info they ask for and plug in all of his meds including Revlimid and it will tell you the cost of all of the Part D plans avail in Washington from the lowest to the highest. Make sure there is plenty of paper in your printer. OR you can select 3 or 4 plans and they will put them into a comparison format you can review.

[Neil]

Hi again Dawn,
I went into the medicare site and foind Revlimid is not listed at all. Not sure why. May be too new or maybe because it falls into another class. Best to run by his doc to determine how payment would be covered.

[Dawn]

Well I have spent the whole day on this issue…no one still can give me a direct answer…how are the rest of you being billed for this?..how is it dosed?..one tablet daily or ??…my dad will have a fit if he has to drive 200 miles daily for a pill..I am at a loss as to what to do here.

[Suzanne]

It is too new and I believe it is a pill that you can get with a perscription (even if only through a few approved places because of the relationship to thalidomide) instead of an injection so it probably would not come under part B. You don’t need to go to an office or a clinic to take a pill by prescription. My understanding from reading tons of material on plan D is that it will require your Doctor to apply for a special exception for a name brand (or exotic if thay have any classification with that meaning)And you will have whatever co pay your plan calls for for a drug approved with that method(or in that classification). I do not have any idea how long it takes to get yes or no on an approval or whether you are more likely to get approval from one company then another. Plan D is so new I am sure not many people have tries it.The way I understand it right now almost all systems to process anything are on total overload. If I am correct, getting a drug approved does not necessarily make it easier to get. Especially these drugs that are thousands of dollars per dose or per month and those that are not needed by a lot of people and therefore get don’t get called to the attention of insurance company formularies quickly because of demand.I would think it is to the drug companies benefit to get it on the approved lists-maybe one of the reasons they advertize that they sometimes can help in the beginning. But it honestly seems to me that we are in better shape to have access to these drugs during the trial phase when the actual drug cost is covered by the drug company.

[CathyW]

I am currently taking Revlimid. It is mailed to me by Cura Script Pharmacy. My doctor had to register with Celegene for this specific drug. They called me and interviewed me and then made arrangements to mail it to me. They give you 21 days worth of the drug and then call you again for the next month’s supply. The insurance company picked up the entire cost – and usually I have a co-pay. However it is considered chemotherapy so I thought maybe the entire cost was picked up because it is a treatment rather than a medication.

[Suzanne]

Fantastic! I gather your insurance company is a private one-not Medicare plan D!

[CathyW]

Yes I do have private insurance and probably should not have posted a reply under this topic, but it seems like a lot of people are having difficulty obtaining Revlimid. I wanted to mention that it is mailed to you and that you don’t have to drive for hours to one of the few places that has it. Your doctor has to go through hoops to get it for you, there are so many doctors who want Revlimid for their patients that I hear there is a waiting list.

[Suzanne]

I suspect the best thing no matter what insurance is involved is that if somehow during the process they are successful getting it totally categorized as chemotherapy(which I think it shoud be)-then most of us with any kind of insurance coverage would be covered for that huge cost that I am hearing about.

[Carl]

Dawn and Suzanne,

I am on Revlimid and it comes in a capsule form. My private insurance pays for all but a co-pay and like CRPWPV said it takes some gymnastics by the Dr. and some delay getting the drug by mail. My Dr’s office said the total cost before insurance is about $7,000 for a 28 day supply so I’m trilled to have the insurance pay for it.

Perhaps Medicare will catch up with the private coverages soon and people on Medicare can get it more easily.

[Author]

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