Paying for Zytiga - medicare?

DebbieMH said...
Any suggestion on a Plan D medicare supplement/advantage plan that will actually help pay for Zytiga? Thanks.

Hi Debbie, I am sorry I do not know the answer to your specific question about Zytiga.

However, I do want to make you aware that "open enrollment" when it rolls around again, you may change companies but not the type of plan.

In other words, if you start on "advantage" plan, you cannot change when open enrollment comes around again to a supplement "F"

Supplement "f" is like having a gold/platinum card when it comes to medical bills. Anywhere you go that takes medicare, you have no more to pay (other than items not covered by Medicare.)

Supplement "F" does cost more, but it only takes one problem to cover the costs.

Someone I know, took the Advantage Plan (people with serious concerns think it should be called the Disadvantage plan) and planning to change during open enrollment to Supplement F. Nope, doesn't happen. You get to change the company, but not the type of plan.

Also, companies and specifics change from state to state and region to region.

I am in South Carolina, the other person I discussed is in North Carolina.

Since you are posting here, I suggest you may want to pursue "supplement F" or whatever option you have available to you that makes payment in full.

Sorry I was unable to answer your specific question, but I hope I have helped you in terms of Supplement F, and Advantage.

Thanks. He is currently covered by United Healthcare F plan .... but, you can change D plans, I think. I will start calling around and seeing what are options are on Monday. I do appreciate all the advice I get and read on this forum.

Debbie,

As you know Medicare part D covers drugs such as Zytiga, so a supplemental plan, such as F, which covers Medicare Parts A&B will not help.

You might try to get him on a Zytiga drug trial - at /clinicaltrials.gov/

Or apply for a grant, or extra help, via a nonprofit organization - /www.cancer.org/treatment/finding-and-paying-for-treatment/understanding-health-insurance/if-you-have-trouble-paying-a-bill/prescription-drug-assistance-programs.html

I don't believe the discounts provided by drug manufacturers are allowed for Medicare Plans.

Bobby Mac

Debbie MH - You are correct that open enrollment for Part D prescription plans began on October 15th and runs through December 7th. By all means you should shop around and compare stand alone Part D prescription plans for your husband. The easiest way to do this is via Medicare.Gov website. It is an excellent, user friendly website developed by the government to assist people in all things Medicare. There is an entire section on that website that is devoted to Part D plans. You are able to create a custom drug profile for your husband using that website that includes all of the medications he currently takes. The website then takes that information and price shops for you from all available stand alone drug plans that are offered in your region. Make sure you are only looking at stand alone drug plans - not drug plans embedded in an advantage plan, because you don't have an advantage plan and I assume you don't want to lose your Supplement F at this point. You then can directly compare monthly premiums, retail pharmacy costs, mail order costs, formulary inclusion, drug tier levels by drug, co-payments by tier, identify preferred pharmacies for the best retail pricing for that drug plan, figure out the impact of the donut hole, etc. It is very rare for the best prescription plan for an individual happens to be offered by the same insurance carrier that is carrying their Medicare Supplement Plan - which seems to be what you have right now. Having said all of that, the bottom line is that many of these medications are very expensive and there is no way around the donut hole unfortunately. That does not mean however that every plan is equally bad. I realize that is not much of an endorsement, but it is what we have right now. You should be able to tell pretty easily on this website which plan will work best for you - based on the information you have about drugs as of enrollment. You can even enroll in a plan directly via the website. As an extra precaution, once you identify the plan or plans you think may work, you can then go to that plan's website directly and verify your information. Good luck in both your husband's Medicare choices and in his treatment.

Wow .. great! Thank you!

until Zytiga was (finally) covered for my husband, we had to buy it ourselves. He took 1/4 of the dose with a low fat breakfast as per a study that was done that reported a similar effect. Of course, 1/4 dose means 1/4 of the cost. I'm happy to send you the study and more info if it is of interest.