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MediCare Drug Plan - what drugs possible prescribed?

Elaine W

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My brain has been so full of things to learn and do.

The deadline is only a few days away to declare what MediCare Drug Plan to have.

For those of you not familiar with MediCare -- they have different plans under their Plan D for Drugs and you go through a List to find a Plan that you know or guess will match your individual drug needs for the next year.

Before diagnoses last summer, Stage 3 NSCLC, I rarely needed prescription drugs. Since then I've only got a little nausea med at a Pharmacy. I did get Nupragen shots to do myself but those were thru my Oncologists office so not under the MediCare Plan D.

It's very possible I'll have some harder fight ahead and will really need some expen$ive drugs.

Are there any drugs (ones you get from the Pharmacy} that are common or quite possible that I maybe should consider in deciding what Drug Plan to buy?

Thanx for each of your individual gifts - Elaine W

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I would meet with some of the insurance companies reps. I still have coverage at work, but I am looking at different plans when I retire. Humana seems like they may have a plan to cover most drugs. Some of the newer drugs Like Tarceva and Avastin can run as high as $3,000 to $4,000 for a months supply, so you want to get the best coverage you can. They should be able to advise you.

Stay positiv, :)


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Thanks for you willingness to kick in with some suggestions for me.

I want to clarify myself again on MediCare. I'm in CA and I don't know how other states go, however it's sorta like this:

- Plan A is for hospitalizations

- Plan B is for Doctor Visits. I think my chemo is under Plan B.

- Plan D is for Drugs at the local Pharmacies

My Pharmacist had been reluctant to say anything, even though I told him I was just asking for general info. Oh, well, he's a great guy and has helped me lots on other info. I like to use a small pharmacy rather than a big chain drug store one.

I got a brief phone call from my Oncologist today. He's a good guy too. We mentioned Nupragen shots for the White Blood Count, about whether it could be thru him or thru the Pharmacy next year, and he said that it's hard to say because of several factors that are unsettled right now.

My Oncologsit said on Pain Pills most every plan covers a few generic ones to choose from. I'm currently not taking any pain meds. I'm the type to use pain management techniques first and I do as many procedures as possible without sedation, and go home after without pills. However I'm not saying I won't be taking pain pills later.

Zophran has been mentioned. That is one I was prescribed but so have haven't needed to use it, except when they put it in the drip with the chemo.


I could just conjure up in my head some secondary condition, some creeping weird thing I haven't learned about yet, one that might need some Very co$tly pills. I like having a reality check like this.

I've had trouble with my white blood count and we haven't been able to get very agressive with my case, so though I have very good health habits I just might have a bigger costlier fight by the middle of next year.

An aside: New to all this MediCare. When I was nearing 60 I said I was a Jr. Senior Citzen. Then when I turned 60 I kept some denial and wouldn't give up saying I was a Jr. Senior Citizen, intending to admit it fully when I was 65, which I didn't -- although I don't mind telling people my age and I dress older and more modestly and most of my good best friends are sages my age.

I'm glad at least I got old enough for MediCare before the diagnoses. Maybe I delayed it some with brocolli. Wow the taxpayers have already had to pay a lot for me.

Still open to the enlarging the List of Pharmacy drugs one might have for Stage 3 or 4 NSCLC, though it looks like the cost of all the other things is a concern too.

Thanx, Elaine W

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Oooohhh, strolled down that path today myself. I called the Doctor after finding any possible medications that Tony might be on for Part D beyond what he already has taken. Alimta & Avastin showed up on the formularies for the plans, but the Onc's office said they run those through Medicare Part B.

We had Humana in 2006 and they had no "gaps or holes" in their overall coverage. They covered his Tarceva with a 60.00 co-pay per month (3200.00 per mo. total cost for Tarceva at Walgreen's). In 2007 it appears that EVERY Part D plan has the "hole or gap". The plan stops paying on everything (AARP & Humana will only cover generics during the gap) from 2400.00 through 3850.00 of total drug cost. Yikes -- more big bucks out of pocket this year. We switched today to the AARP top coverage for 43.00 per month vs. Humana's 86.00 a month in 2007. (Only reason was that Humana Complete was making courtesy phone calls to remind people that they now have a gap in their coverage for 2007. I have a gap in my brain and failed to notice this info, so their "heads up" lost them a customer. After the Tarceva, they are probably happy to see us move on. :) ) Humana also required "permission" to use Tarceva last year, but it wasn't a problem.

Muriel covered most of the drugs. I would add Lunesta/Ambien CR and the "swish and swallow" drug for thrush in the mouth, Nystatin Oral Suspension. The generic for compazine is prochlorperazine maleate tablet and is a cheap date. Advair inhaler is another thing Tony uses, but I don't know if that applies to you.

I'm shocked at Cheryl's experience!! Cheryl, do you mean you had to pay 30% of the Alimta under Part B?? I'd really like to hear about this.

Good luck and happy choosing. The fun never stops with Medicare!


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Oh, Medicare. What a jungle!

Mom's meds (given IV or by a shot) for blood counts were covered under Part B as long as they were given at the onc's office. All IV chemos should be covered under Part B as well. Oral chemos taken at home, such as Tarceva, are covered under Part D or whatever private pharmacy insurance you have.

We had private insurance for pharmacy coverage under mom's retirement plan, so we never did the Part D route. However, I did investigate it to see if there would be any cost benefit to mom to use it instead. The problem with picking a plan is that the insurance company can change the formulary of what they prefer to cover over time, making it very difficult to insure that you can get what you prefer (I'm a big personal believer that substitutions are not all created equal, I don't care what "they say"). Plus, Part D plans are handled through private insurance carriers across the country, making it necessary to find out exactly what options are available in your area.

Then there's the expense "hole" in all Part D coverage already discussed in this thread. Individuals have to look at that in relation to their personal circumstances. However, the good news there is that your out-of-pocket co-pays you paid before you hit "the hole" count toward getting through that hole as I remember. There is supposed to be extra help available for those who have a hardship in covering expenses like this, I just never could clearly understand exactly what that was in the Part D literature.

I don't know what you are using, but here's what I remember of what mom had that her pharmacy plan had to cover: Protonix (digestive), Albuterol (and other drugs related to home inhalation therapy), Lorazepam (antianxiety), Diltiazem and Lisinopril (high blood pressure), Advair (breathing treatment), Glyburide and human insulin injections (anti-diabetic treatments: mom had drug-induced diabetes when this all got going), Fluoxetine (anti-depression), Lipitor (cholesterol reducer), Flagyl and Vancomycin (C-diff antibiotics). There was an oral anti-nausea drug too at some point (I don't remember what it was).

Mom did receive anti-nausea medication during her chemo treatments which was covered under Medicare Part B. She also received her decadron and benedryl during chemo therapy so these too were covered under Part B. There may be options on how/when/where drugs are administered to utilize your Medicare benefits the best -- I'd check with the onc. office on what those might be as well. Their (onc's) billing office is another area to ask: the doctors/nurses don't always know the payment option ins and outs.

I had to get mom a 3 month supply at a time of all "maintenance" Rxs in order to get the best cost reductions under her particular plan (the plan determined what was a "maintenance" drug too). That was a challenge when drugs can come and go quickly, depending on the patient's changing needs. Anyway, for rough planning purposes, we were doing $1,100 per quarter for out-of-pocket perscription costs under her existing plan. And it was about to get worse had mom recovered enough to try Tarceva -- we would have been supporting 50% of the cost there. I mention that just to show that it is possible to need to leap through the Part D hole, depending on a person's particular needs. This is why I wanted to look at Part D options in the first place.

Good luck. I hope you find a plan that meets your needs.


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Ours is with Humana as well. We were getting the bill of $10,000 every three weeks with the addition of blood work and Dr. fees that bill totalled over $11,000 for every three weeks. Our part was around $3,000. Of course we were on a clinical trial(Alimta-Perifosine) and the thinking was is that the trial was supposed to be payed for by the drug Co. Well, yes, the Drug Co. payed for the trial drug (Perifosine) but not the standard chemo (Alimta) that was given with it. On top of that, the trial didn't work for me. Not enough sugar for a dime. I really believe, after going thru all of this, that the more you know, the more worried you will be. I am learning that it is almost better to play they their game and not ask any questions, as strange as that may sound. Get the treatment, worry about all of the rest after that.


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Disclaimer: this is sorta how I understand it for now as I'm still trying to figure it out.

I've found that besides guessing what Drugs I may need for 2007, that knowing how to guess for another factor called the "donut hole", a gap in coverage, when you hit abt $2,400 in drug costs until you hit about $3,800. There are several parameters involved in how it works and there are usually 3 levels of monthly cost per provider choice.

Today a company rep said that with cancer he thought I'd need more non-generic specialty drugs, and ones that are highly expensive. He said, and he just might be right, that I'd do better to sign up for a low cost insurance and then I'd run through that gap faster.

After going thru the gap, past abt $3,800 out of pocket for Pharmacy Drugs, then it's just 5% of the drug cost I'd have to pay.

Been spending a lot of time on this and learned only a little more. Being unsure about this gives me more incentive to take care of myself and avoid falling into a cost chasm. I don't think socialized medicine can solve the health problems of the masses either though.

Here's to me making it to this time next year, then I've have figured it out better for 2008.

Elaine W

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