Sutent and Medicare

Qt34167

I go on Medicare next August and with supplemental I am still on the hook for 33% of Sutent cost Because it is a type 5 drug  Can anyone tell me what the Medicare contracted rate is?  Anyone else experience this?

Dutch1

Sutent and medicare

Hi there;

I was on Sutent up through November 2015.  At this time, I was on Medicare -- not an Advantage plan.  Thus, I had coverage under Medicare, under my supplemental coverage policy (as you do) AND under a Part D (prescription) plan.  The Part D plan has a progression of co-pay steps, topping out at a 5% co-pay after you've hit the highest level.  That is where I was in November. 

At that time, I was getting 12.5 mg pills.  My cost was $6.79 per pill.  The plan paid $129.11 per pill.  Total cost of $135.90.

I hope that this helps you.

Dutch

 

mrou50

Check with your Onc

Often times the pharma companies can give a discount through loyalty programs and grants to help with the costs, check with your med team and if your Onc team has a social worker that person could help with the paperwork.

 

Mark

Qt34167

Dutch1 said:

Sutent and medicare

Hi there;

I was on Sutent up through November 2015.  At this time, I was on Medicare -- not an Advantage plan.  Thus, I had coverage under Medicare, under my supplemental coverage policy (as you do) AND under a Part D (prescription) plan.  The Part D plan has a progression of co-pay steps, topping out at a 5% co-pay after you've hit the highest level.  That is where I was in November. 

At that time, I was getting 12.5 mg pills.  My cost was $6.79 per pill.  The plan paid $129.11 per pill.  Total cost of $135.90.

I hope that this helps you.

Dutch

 

Supplemental d

who do you use For the supplemental D

Dutch1

Qt34167 said:

Supplemental d

who do you use For the supplemental D

Sorry to have missed your

Sorry to have missed your question.  I sent a "private message" to you in reply.

Dutch1

NewDay said:

Catastrophic coverage

I assume you have a part D plan in addition to your supplement.  If so, you only pay the 33% until you have paid $4,950 out of pocket.  Then you enter the catastrophic phase and will pay 5%.  Unfortunately that is still a lot of money.  The retail cost of my Inlyta is $12k per month.  With a Medicare Part D plan, my total drug costs for the year will be about $11k.  However, there are foundations that may help cover some of that.  Pfizer has a copay assistance program.  Since you are not yet on Medicare, you may currently qualify and get your copay down to $10 per month.  Although it is illegal for Pfizer to directly provide copay assistance to anyone on Medicare, they can still help you get assistance from outside sources and they do all of the legwork for you.  Just go onto their website for more info.

To get an estimate of what your drug costs will be, you can go onto Medicare.gov and enter the drugs you take and it will give you an estimate of your cost for each insurance company.  You can also compare Medicare Advantage plans for medical coverage if you should decide to go that route instead of a supplement.

Kathy

A good summary of the

A good summary of the insurance side of chemotherapy.  And, a good reminder of the third party assistance that might be there for a cancer patient.

NewDay

Catastrophic coverage

I assume you have a part D plan in addition to your supplement.  If so, you only pay the 33% until you have paid $4,950 out of pocket.  Then you enter the catastrophic phase and will pay 5%.  Unfortunately that is still a lot of money.  The retail cost of my Inlyta is $12k per month.  With a Medicare Part D plan, my total drug costs for the year will be about $11k.  However, there are foundations that may help cover some of that.  Pfizer has a copay assistance program.  Since you are not yet on Medicare, you may currently qualify and get your copay down to $10 per month.  Although it is illegal for Pfizer to directly provide copay assistance to anyone on Medicare, they can still help you get assistance from outside sources and they do all of the legwork for you.  Just go onto their website for more info.

To get an estimate of what your drug costs will be, you can go onto Medicare.gov and enter the drugs you take and it will give you an estimate of your cost for each insurance company.  You can also compare Medicare Advantage plans for medical coverage if you should decide to go that route instead of a supplement.

Kathy