Tykerb and Medicare

[Stephanie]

I have a question for my mom, who will be going on Tykerb just a soon as we can get some. The onc office was dealing with Medicare and her supplemental insurance on this today, and my question is--have your insurances been treating Tykerb as a prescription drug with a copay (like an antibiotic) or as a chemo, with whatever percentage you usually pay for chemo or herceptin?

We had this problem when she started on Xeloda--Medicare was treating it as a prescription, and her secondary insurance was charging a horrendous copay. We got that reimbursed and straightened around, and now we're having the same problem with the Tykerb--they want to charge her a prescription copay for it. It seems to me that the Tykerb should fall in the same category as the Xeloda, and be covered like chemo and herceptin are covered.

Any input is greatly appreciated! Thanks in advance.

[Lolly]

Stephanie,

I had the same problem and when I contacted my insurance provider was told the problem is with Medicare's billing code for Tykerb, and the insurance providers have no control over how the government codes Tykerb.

Xeloda was a reasonable co-pay, but Tykerb is viewed as a "specialty drug" which puts it into a different class. I was advised to take it up with Medicare, which I haven't had time to do yet. However, the light at the end of the tunnel is that after 3 months of high, high co-pay's I finally reached my maximum annual out-of-pocket amount and it's now appx. $170 a month.

Thanks to Christine's heads up, I just participated in GSK's teleconference regarding the news release on food/Tykerb interaction(GSK's advice is follow the FDA approved use, which is "on an empty stomach"), and I asked the GSK moderator about this issue of Medicare/Tykerb. She said GSK is well aware of the difficulty for patients, although GSK can't effect a change in Medicare's policy. They advise patients who face a high co-pay to get in touch with:

"TykerbCares"
http://www.tykerb.com/tykerbcares.html

and they will guide you through the Patient Assistance process for financial assistance with the cost.

Hope this helps, let me know if I need to clarify.

<3 Lolly

[Stephanie]

Thank you, Lolly, I really appreciate the info. I will pass it along to my mom.

Regards,
Stephanie

[hutchibk]

From what I understand, GSK Access/Tykerb Cares program will carry you through the donut hole on medicare Part D...