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Maintenance Chemo Pills

Anonymous user (not verified)

MRI shows the liver tumor is gone and the chemo shrunk the cancer in many of the lymph nodes including the aorta lymph node.  The doctor wants to do maintenance chemo pills but says they are very, very expensive and insurance does not treat it the same as intravenous chemo.  Has anybody had experience with the maintenance chemo pills?  He still goes in for chemo every other week but no longer getting oxaliplatin and irinotecan.  He received 10 treatments with the oxaliplatin and irinotecan and has a lot of neuropathy......hoping, it isn't permanent.    

SandiaBuddy's picture
SandiaBuddy
Posts: 912
Joined: Apr 2017

I took the capecitabine pills and they were covered by insurance on the same terms as IV chemo.  But without insurance, I imagine they would have been very expensive.  Before I met my out of pocket maximum my copay for two weeks was about 1,100USD.  After that, I hit the OOPM and did not need to make the co-pay.

Butt's picture
Butt
Posts: 325
Joined: May 2018

I don t know about the insurance that you have. I was told by an MD Anderson doc that they effective on average for 8 Months. They do use them for a Maintence chemo.

Annabelle41415's picture
Annabelle41415
Posts: 6249
Joined: Feb 2009

If your insurance doesn't cover it why can he not go on an IV of maintenance chemo.  The doctor should work with you on the insurance portion if they know one isn't covered and one is.  I'd go ahead and ask again if there is something else he can take that is covered. 

Kim

Mikenh's picture
Mikenh
Posts: 777
Joined: Oct 2017

I also took the capecitabine pills and the retail cost for Neo-Adjuvant (28 days) was $8,000 and about $5,000 per cycle for Adjuvant Chemo (I had 8 cycles). Generic would have cost somewhat less. 5FU has been around for many decades so it's off-patent.

lhduffer
Posts: 72
Joined: Oct 2015

I also took the capecitabine pills for my neo-adjuvant chemo and then neo-adjuvant chemo/radiation.  For the neo-adjuvant chemo, I was on a pre-ACA plan which did not cover prescription drugs and it was, therefore, not covered by insurance.  However, the 5FU would have been.  I elected to go with the capecitabine due to convenience and the recommendation of my doctor, but it was very expensive.  It was going to be $2500. for 14 days.  I utilized the GoodRx app and was able to get it for $1250.  Currently it is $900.+ on the app.  There is some need based help out there from different organizations which may be worth looking into.

For my neo-adjuvant chemo/radiation and adjuvant chemo, I was on an ACA plan and the capecitabine was covered with a $10. copay.  As mentioned, you should discuss your options with your oncologist as they may be able to help or recommend an alternative.

tanstaafl's picture
tanstaafl
Posts: 1292
Joined: Oct 2010

Capecitabine   prices are lower now if you shop around. Capecitabine  is the generic name of Xeloda,   Assume you needed 120 - 168 tablets per month,  that would be $600 - 824 at the lowest prices with the coupons from www.goodrx.com/capecitabine  (today)

My wife has used customized forms of daily maintenance chemo for 8 years with better results by including other mild drugs like celcoxib, targeting, and high potency supplements. It is possible to improve inhibition and reduce side effects this way but you have to search out information beyond ordinary oncologists.  Her oral chemo, tegafur-uracil, not available in the US because of FDA failures, is cheaper and milder, but capecitabine would be the US replacement.

 

Betsydoglover's picture
Betsydoglover
Posts: 1255
Joined: Jul 2005

Hi -

In terms of insurance companies coverage of Xeloda, many (not all) do treat them as prescription drugs and so your prescription drug copay applies.  When I was on Xeloda it cost me $30 every 3 weeks as a "Tier 3" drug.  Medicare, for example, uses regular Part B to cover oral chemo and so the cost ranges anywhere from 20% of the cost down to $0 if you have a Supplement) - I'm sure some other ins works that way also. You should check with your own insurance provider and not take your onc's blanket statement as truth for your situation.

Take care,

Betsy Stage 4 - NED since 2009)

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