$2100???

Lolly · 05-12-2007, 08:18 PM

Elaine, I have Medicare and my prescription plan considers it a Tier 4 prescription so it's at the highest co-pay, 25% for me (total monthly cost of Tykerb is around $3,000). On top of that, even with my plan paying 75% I was thrown into the Coverage Gap, aka The Donut Hole, and my total out-of-pocket for this first month was almost $1,500. Next month I will have to pay $700-$800 before I reach the maximum out-of-pocket of $3,800 and then after that the plan will pay 95% so my share will be $170-$180.

It's a shame the government is allowed to dump the cost of chemo drugs on those least able to afford them, just because they're oral not IV!

Sorry to be the bearer of bad tidings, but TykerbCares does have a Patient Assistance program to help bear the cost.

<3 Lolly

Sheila · 05-14-2007, 08:32 AM

What a difference we all have in out insurances. Although I haven't taken the Tykerb yet, I do know that my husbands BCBS of IL pays for my Xeloda through Caremark. I get 280 tablets (500mg) sent via the mail through their Onc. Med Dept, via FEDX, and my cost is $5.00....I would think Tykerb would be the same....although the hospital way overcharges for my Herceptin every 3 weeks (10,000), I don't pay a dime. I just got a new shipment of Xeloda. If she takes me off it next week when I go to see the onc., and says I am not going back on it, I will be glad to send it to someone, its never been opened. I will see what she says...I guess i am lucky to have my husbands insurance.

Odette · 05-14-2007, 08:41 AM

Sheila,

unless sy else needs it more I'd love to have it, right now I'm taking a week's supply of a friend's who is off of it but after this is out I'll have to pay for it - I think it is about $ 900 (+) for a month's supply.

Eventually I hope to be on assistance/fight it out with insurance but that might take a while.

Thank you so much for the offer!

Odette

Odette · 05-14-2007, 08:47 AM

Sheila,

I'm just reading your signature and your progression sounds a lot like mine. Have you discussed radiation of the nodes with your oncologist?

I had that done it was terribly painful but effective for me. How about adding Tykerb to the Xeloda?

Second opinion?

Hugs and prayers,

Odette

Shell · 05-14-2007, 09:40 AM

Joy-

Brenda's advice sounded right on, and I hope you get the answers and reduced costs as a result. I am like Sheila, in that I'm very grateful my husband's insurance - it covers all but my co-pay of $19/month for tykerb.

Stay postive and focused, and I'm sure things will work out for you.

Kind regards,

Sheila · 05-14-2007, 03:49 PM

Odette

I won't know if the onc. will keep me on the Xeloda yet, I will find out next Monday when I go for my Herceptin...this is my week off and my feet are really hurting. I don't seem to be havig a good response to the Xeloda this time, but I haven't taken 6 cycles yet...if she changes me, I will send you my "stash."w

Odette · 05-16-2007, 11:30 AM

Yesterday my nurse calls: my oncologist got a fax that Anthem is going to cover my Xeloda. Yess, it is in writing now.

This morning at CVS to fill my prescription, I inquire what is my copay?
So the lovely pharmacist calls the special line reserved for pharmacies, they put her on hold, then hang up on her then the answer comes: my copay is 100% = $1250 for two weeks of Xeloda.

The reason they gave her is that it is a brand name; my coverage is good only for generic.

Crazy, I was so upset I forgot to get the other things I wanted at CVS, then went to the grocery store then drove home w/o my groceries.

I guess I should not take it personally. I think I'll drive to Canada over the weekend and get it there; it is only about $ 900 according to my research.

My only consolation is all of you gals, following and sympathizing and the letter that I'll write to the insurance company.

Love and hugs,

Odette

Odette · 05-16-2007, 11:50 AM

Oh Sheila,

I'm so sorry to hear that your feet are hurting so much, you would probably like to be off the X.
This insurance business makes me feel like I stepped into Franz Kafka's novel The Trial. I hope things work out well for you either with or without the Xeloda.

Please just e-mail me if you really do not need the rest of your X pills.

My prayers and good wishes are going your way,

Odette

vickie h · 06-01-2007, 01:52 PM

Joy, I called Tykerb Cares when My insurance refused to get me to a specialty pharmacy and pay for the Tykerb. I called 866-489-5372 and they were absolutely wonderful. They worked everyday for 2 weeks to get me the medication and my co pay ended up at 20 dollars a month, this was after my insurance refused to pay for it! Keep calling your insurance, but I would trust that the Tykerb Cares program will do most of the work for you. They were relentless in getting me mine. Much love and luck to you, Vickie