Cancer and Medicare

I've been NED for about six months, now. I have PET/CT scans every three to four months. Through my whole cancer ordeal, biopsies, radiation, chemo and one hospitalization due to a bad infection, I had a super group health insurance plan and only had to pay a handful of co-pays for office visits.

In September I will be losing the health plan and going on medicare with a supplement (Plan G). What have been your experiences paying for post-treatment with medicare? And not to be Mr. Doom-and-gloom, but what if the cancer comes back? The only drug I know is covered for sure is Cisplaten, (under Part B). Are Tarceva and Avistan covered? Taxatol? Anybody's experience would be most helpful and appreciated.

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Tarceva, an oral chemo drug, for my wife was covered by my former employer's retiree optional drug plan. That plan is "equivalent" to Medicare Part D, with differences including higher cost to me than most Part D plans, and no "donut hole" where there is no coverage. Our copay was about $11/pill. The iv chemo drugs have been totally covered by Medicare Part B and my former employer's retiree optional Medicare supplemental plan.

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Thanks, drrust. I am relieved to know that the chemo drugs are covered. When I am selecting a plan B, I will check if the Tarceva and Avistan are covered by the formulary for that plan.

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For people who do not have coverage for specific drugs, often the company that produces the drug has a patient assistance program, either to provide co-pay assistance or to provide the drug for free if necessary. Avastin and Tarceva are both produced by Genentech, which has a very good program for assistance. Alimta and Gemzar are two other common lung cancer drugs and Lilly Oncology produces them. They too have a good patient assistance program from what I understand.

You can reach Genentech at 866-422-2377 and Lilly at 888-443-6927. Hang onto those numbers in case you need them further down the road!

Amy
LCA

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Thanks, Amy. I just looked up Tarceva and
Avastin in the AdvantaRX furmulary. They are tier 4 drugs, meaning the highest co-pay. They would cost together around $4000/year. I will check with Gentech to see if I qualify for assistance.

It may seem ridiculous that I am concerend, since I am NED after my initial diagnosis 2 years and 3 months ago, but the prospect of losing my all-inclusive plan has got me thinking about the disease, again. I get the same willies just before a scan. :-p

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When I had a situation where my employer-sponsored drug plan wouldn't pay for a prescription for Emend, Dr. just ordered from the hospital pharmacy while I was there for treatment and it was then covered by my hsopitalization insurance.

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Why does Avastin and Tarceva cost so much. What is in them that would cost the manufacturer so much?
Are these drugs that are only used for NSCLC? I see them talked about but it seems just for NSCLC. I am just thinking ahead.

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They cost so much because, the drug companies claim, they have tens if not hundreds of millions of dollars in research money invested in their development. Because of this, the drugs are protected by patents so the companies can charge whatever they want. When the patent runs out, other companies can copy them, which is where the generics come from. I don't know when the patents will run out for Tarceva and Avistan.

I am of two minds. Although I am sure the drugs cost only a few dollars to manufacture, there would have been no incentive to develop them in the first them if not for the chance of making HUGE profits. So we have the drugs--but pay the price or go without! Fair? I don't know. The only answer I can think of is more government money going for cancer research, so the drug companies can't gouge us.

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I say pray for patents to run out soon.....you notice all the drug companies and insurance companies are not having money problems. The insurance companies are the wealthiest companies in the US. But we sure can not do without them....

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Dear Famous Person,
The week I turned 65 and my Medicare A and B and Mutual of Omaha supplement clicked in, I was diagnosed with NSLC Stage 3A. That was four years ago. Last year the lung cancer came back in the other lung and the remaining lobe of the original lung cancer site. I have not had to pay "ONE PENNEY" for my cancer care since then till yesterday when my first pack of Tarceva arrived. I had to pay a co-pay of $50 for 30 days of pills. But the Chronic Illness Assistance program will not confirm their funding assistance until I send them our income tax form to prove our income. So, the bill will be $4,000 (per month?)without their help each month. As for Avastin, which didn't hold back the tumors this past three months. That drug charged my insurance $27,000 in April, down to $13,000 in Dec. for each infusion. So that is what I have experienced with costs. Without insurance, I would have a nervous breakdown probably. I am not "home free" with the Tarceva charges as we are mid-income people and retired....Anyone want to confirm the Tarceva costs? cynthia from MO.

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Cynthia,

I am really sorry to hear that you have had a reccurance. I wish you the very best of luck (and treatment) in dealing with it. Please keep us informed as to your progress!

It was Omaha of Mutual's medicare supplement plan I was leaning towards, but it doesn't have part D (drugs). Are you referring to their advantage plan? I looked into AdvantaRx's Part D and it appeared that the Tarceva would cost me a little over $4000/YEAR, including the premium, if I read the information on their site correctly.

If the Avastin was adminstered to you by infusion, it MAY have been covered by part B, as a number of other infused chemo drugs are (cisplaten, for instance). Does anybody know for sure if that's a part B drug? I don't want to be throwing misinformation around!

Incidentally, I have NO income, since the economy tanked, yet Medicare determined that due to some capitol gains in 2006, my premium for part B is
DOUBLED! I think my 2008 tax return will show that I shouldn't have to pay the surcharge. I don't know if I will qualify for drug assistance. Thank God for Social Security.

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Around here we stay away from any Advantage Plan (I'm a clinical social worker and we advise against that plan) My part D was Humana and it was good but the premiums went up so my pharmacy guy suggested Community CCRx basic, which so far has been good and the premium is ten buck a month under Humana. You are correct about Avastin being infused at the hospital...it is under Medicare Part B so it is covered. The problem with Tarceva is that it is taken at home daily...removing it from the hospital setting so it goes under my CCRx part D plan. It is in the upper tier and so with a call from my oncologist it was approved. So far the price quoted with my first 30 day supply with my current med deduction spent, was $2940.00. I was so shocked I failed to ask if that was for one month's supply. We a currently filling out the papers for help from the Chronic Disease Fund. You should definately qualify if we do. We are stock market people and we took a beating this past year after retiring...yes PTL for social security....cynthia

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Famour Person, I wanted to add this to my reply. My husband and I just changed our supplementary health insurance policy from Mutual of Omaha to United of Omaha b/c our insurance person said it was a lot cheaper and the same coverage. cynthia

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Cynthia,

I am encouraged that you have had such good coverage with medicare and your medicare supplement. United of Omaha doesn't sell medicare insurance in PA, so I can't compare it to Mutual of Omaha. I didn't know that you could change medicare supplement companies. I thought that once you had made your choice you were locked in. Judging from your experience, that's not so.

On the medicare.gov site there is a page where you can type in your prescriptions, and the program will bring up a number of part D plans for you to compare. For the drugs I take (none of them cancer drugs), AdvantaRx comes up the cheapest in my area. You might want to give that a try, including Tarceva in your list. I'm sure that the $2940 was a real shocker! I hope that's for a year.

Peter

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The negative for Avanta in my area was that many physicians had not signed on as providers so if you got the plan...you had to shop around and find a doc that would honor it. Your area might be different. Yes you can change every January here in MO. I have plain Medicare A and B that is automatically deducted from my social security check. My supplimentary Medicare medical insurance is United of Omaha and I pay that quarterly. My Part D (drug) is Community CCRx and I can't recall how I pay that...(today is chemo brain time I guess). Hey, maybe you won't have a reoccurrance and you won't need to deal with this stuff. cynthia

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Hey, I hope you're right! It's just that all this medicare stuff has me over-thinking my health. As soon as I've selected a plan I'll get back to my old laissez faire self. Until, that is, my next scan in May. That always shakes me up for a day or two.

Thank you VERY much for all the information!

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Here's a possibly useful resource that discusses Medicare:

http://www.curetoday.com/index.cfm/fuseaction/article.show/id/2/article_id/ 981

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