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Lupron 22.5 mg changed to trelstar 11.5 mg

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Posted 12/2/2017 12:41 AM (GMT 0)
Today I went for my three month Lupron shot and was informed that Medicare no longer pays for Lupron under part B but instead pays for trelstar under part D. So I now have a co-payment whereas Lupron was fully covered. No big deal . My Urologist said it’s all about Medicare cutting urologist’s mark-up on Lupron to reduce costs. Frankly it’s ok with me as long as trelstar works as well as Lupron.
Bob
Posted 12/2/2017 3:19 PM (GMT 0)
I don't know if they all are equal; but I wonder if your side effects might get better. It seems like changing to a different medication might help.
Larry E
Posted 12/2/2017 8:04 PM (GMT 0)
But now that its under Part D will you have large out-of-pocket expenses? After reading your message and because I'm heading into ADT sometime soon, I just checked the formularly for my BlueCross Medicare Advantage Plan. They list Trelstar as Tier 5 under their plan. This means I have to pay the first $405 annually and then pay 25 percent of the cost of each injection if the drug itself is not considered part of the office visit under Part B.

If it was under Part B it would cost me only the plan's $40 co-pay for a specialist office visit.
Jim
Posted 12/2/2017 9:52 PM (GMT 0)
Bohemond
Ask your urologist, but I was told that Medicare decided to stop paying for Lupron purchased by urologists and resold to patients when injected to remove the urologist’s markup which had been reimbursed under Medicare part B. Instead it must be purchased by your urologist from an approved specialty pharmacy and the patient must pay the co-pay under Medicare Part D.
So yes your prescription costs will go up due to this switch from Part B to Part D. Your copay depends on where you are with respect to the Medicare Part D donut hole . My copay was only $123 as I’m over the annual out of pocket maximum.
I forgot to ask why I was switched to trelstar from Lupron but my urologist said that Lupron was originally chosen by Medicare because it was cheaper. But now it isn’t. I guess I’ll google it and get more facts.
Bob
Posted Yesterday 1:02 AM (GMT 0)
Interesting. If my copay ended up only $123 or so per injection after my insurance plan's initial $405 out of pocket, that wouldn't be too bad - maybe $800 or so per year. I'm with an MO at Dana-Farber so I'll ask when I see him in January. There was someone on this board who said he was treated at Mass General but coordinated with the VA so he had his prescription for Lupron (or Trelstar?) filled by the VA but was still injected by MO at Mass General. If it's only $800 or so per year it may not be worth the hassle, but if it amounts to a lot more, I will ask if I can do something similar. Dana-Farber and Mass General are both subsidiaries of Partners Healthcare so I would think what is done at MG could also be done at D-F.
Jim
Posted Yesterday 5:41 PM (GMT 0)
As I said, my copay was low because I’ve reached my out of pocket maximum under Medicare Part D. Starting next year when I start over again the copay is probably around 30-40% which will be more like $1000+. All I can say is thank goodness for the out of pocket cap given all the Meds we take for cancer . Plus the donut hole is closing gradually so there won’t be any in the near future.
Bob
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