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Lolly · 04-25-2007, 06:53 PM

This is what I've discovered:

Tykerb is not covered under Medicare Part B which covers INFUSED chemos at 100%, but rather is covered under Part D as an oral prescription medication. With some Part D Prescription Plan it's classified a "Tier 4 Specialty Drug" and co-pays are usually around 25%. When one's total out-of-pocket drug cost reaches $3,850...then you qualify for the Catastrophic Coverage and will only pay a small percentage of the monthly cost, depending on the plan.

Some plans have what's termed an "exception" classification which must be applied for, which reduces the monthly co-pay. This can make it a little easier to budget. One still has to reach the out-of-pocket maximum of $3,850 before dropping back to lower co-pay; basically just stretching out the co-pay over more time which would be a good option for some...however, this also delays getting the drug in hand as the additional "paperwork" takes several weeks.

This is where GSK's Patient Assistance Program can be very helpful.

I wanted to get this all on the board here in case anyone is having to go through Medicare for Tykerb.

<3 Lolly

04-25-2007, 06:53 PM	#4
Lolly Senior Member Join Date: Aug 2001 Location: Oregon Posts: 1,756	This is what I've discovered: Tykerb is not covered under Medicare Part B which covers INFUSED chemos at 100%, but rather is covered under Part D as an oral prescription medication. With some Part D Prescription Plan it's classified a "Tier 4 Specialty Drug" and co-pays are usually around 25%. When one's total out-of-pocket drug cost reaches $3,850...then you qualify for the Catastrophic Coverage and will only pay a small percentage of the monthly cost, depending on the plan. Some plans have what's termed an "exception" classification which must be applied for, which reduces the monthly co-pay. This can make it a little easier to budget. One still has to reach the out-of-pocket maximum of $3,850 before dropping back to lower co-pay; basically just stretching out the co-pay over more time which would be a good option for some...however, this also delays getting the drug in hand as the additional "paperwork" takes several weeks. This is where GSK's Patient Assistance Program can be very helpful. I wanted to get this all on the board here in case anyone is having to go through Medicare for Tykerb. <3 Lolly __________________ Sept.'99 - Dx.Stage IIIB, IDC ER/PR-, HER2+++ by IHC, confirmed '04 by FISH. Left MRM, AC x's 4, Taxol x's 4, 33 Rads, finishing Tx May 2000. Jan.'01 - local/regional recurrence, Stage IV. Herceptin/Navelbine weekly till NED August 2001, then maintenance Herceptin. Right Mast. April 2002. Local/Regional recurrence April '04, Herceptin plus/minus chemo until May '07. Gemzar added from Feb.'07-April '07; Tykerb/Abraxane until August '07, back on Herceptin plus Taxotere and Xeloda Sept. '07. Stopped T/X Nov. '07, stopped Herceptin Dec. '07, started Avastin/Taxol/Carboplatin Dec. '07. Progression in chest skin, stopped TAC March '03, started radiation. Herceptin has served as the "Backbone" of my treatment strategy for over 6 years, giving me great quality of life. In 2005, I was privileged to participate in the University of Washington/Seattle HER2 Vaccine Trial.