Tykerb and Medicare?

[Lolly]

Anyone receiving Tykerb who's also on Medicare?

<3 Lolly

[pattyz]

First: Congrats on good scans!!


This is a good question and I'll be interested in your responses... My own experience is with Temodar.

Before this 'new Medicare' plan, my Temodar co-pay was $3.00 for 7 pills, as I'm also on state Medicaid.

After the 'new' plan, my co-pay is $513. for the same amount of Temodar... as it is not covered in the drug plan, but goes to plan 'B', ( think I got that right anyway) as several of the cancer drugs do.

Hope we get experienced answers, Lolly!

xoxopattyz

[AlaskaAngel]

Hi there PattyZ and Lolly,

The presentation on insurance issues Sunday might mentioned very briefly a connection between medicare coverage in regard to clinical trials, so it might be worthwhile to see if talking with the people on the phone number for legal assistance might help.

A.A.

[Lolly]

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

[pattyz]

Thanks, Lolly.

Hope the Tykerb will be a 'good' drug for you.

xoxopatty

[Lolly]

Patty, you're welcome...with the "new" Medicare plan it's plain people will end up paying more out of pocket. I hope this gets fixed soon!

<3 Lolly