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Xeloda High Deductible

bobby66
Posts: 69
Joined: May 2017

I was just prescribed Xeloda and my pharmacy is saying that I have to $400.00 deductible. Is this possible that for a cancer medication I have to pay such a high deductible??? Does anyone have to pay this much? What are we supposed to do? Dont take it and die??

Sunnydeecat
Posts: 16
Joined: Aug 2017

Has the doctor completed an authorization request for the medication? that could be the issue. Also you can call your insurance company to find out why the cost is so high. Usually a deductible is the same for all meds. Meaning if your always had a $400 deductible with non chemo meds you would still have the same deductible. it is unusual to have a deductible on certain medication and not others. It is likely that an auth is needed or even a teir reduction. I would say call the number on your insurance card to see what your benefits are also ask if your insurance has any form of care management program, this could be very helpful. Hope this helps some! Also if the $400 is your copay for the medication and you can't do a tier reduction check needymeds.org they have many programs to help with copay, meds etc. I was a care manager for a very large insurance company ( mostly worked with the medicare members) for many years. There are a lot of options to help it's just hard and overwhelming to know where to look, what questions to ask etc. since DH was diagnosed my previous experience working as a medical care manager in the insurance has helped us and save some sanity. Good luck!

NHMike
Posts: 214
Joined: Jul 2017

My insurance plan has three classes of drugs that it covers and the deductibles are different for the different classes.

bobby66
Posts: 69
Joined: May 2017

Thank you for all the information i called the insurance (caremark) and they just told me that "specialty medicines have a deductible. None of my other medications and i take a few including for the tyroid i have to pay deductible. I guess i will look into other stuff.

Sunnydeecat
Posts: 16
Joined: Aug 2017

Definitely check needymeds.org. You will be able to go to the medication and then it will liknk you to all manufacturers assistancesprograms. I just looked and there are several that may be able to assist you.

bobby66
Posts: 69
Joined: May 2017

Thank you so much..

BRHMichigan's picture
BRHMichigan
Posts: 368
Joined: Jul 2017

My deductible for Xeloda was going to be around $700.  The Onc office ended up.giving me samples.

bobby66
Posts: 69
Joined: May 2017

that's an option. thanks..

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

Capecitabine, the generic of Xeloda, is long off patent now. 

I am surprised that insurers or stores have not lined up mail order supplies for a good price, like the Walmart cheap generics.  In large parts of Asia the full retail prices (no insurance at all) run about $2-$4 per 500 mg tablet. That is $168 - $336 for 84 tablets, usually a more than full dose for the two weeks on dose of a 3 week cycle, no insurance at all. 

Pharma and insurers are a ripoff if you're paying so much.  I'd seriously look for a better deal locally and abroad.  Maybe you just need to ask for the generic prescription.

NHMike
Posts: 214
Joined: Jul 2017

My inusrance company would only cover 20 days at a time and my deductible turned out to be $190 for the first batch. I actually need additional eight days and was a bit concerned about having to pay another $190 for the second batch but I had hit my max out-of-pocket so I think that the charge was lower, maybe $40. I have about $40K in retail charges, probably around half that or maybe a little more in negoitated rates. This cancer stuff is not inexpensive. The insurance company also chose to go with the brand drug as opposed to a generic so I assme that the insurance company has negotiated a great rate with the drug company. I've seen the prices for Xeloda in other countries and I can only be envious. I will likely be taking Xeloda again later this year for post-surgical chemo.

bobby66
Posts: 69
Joined: May 2017

So the doctor decided that if I can't afford xeloda she will continue to keep on chemo. I will keep getting 5FU and the cocktails. No other way around it.

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