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Medicare & Co-Pays


Wyde1340

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Quick question (not sure where this would go)...

I'm supposed to start using Medicare in August. The problem is the co-pay for my Tier 5 medication (Crizotinib) is INSANE!! I'm in Pennsylvania,  if that makes a difference.  The question is: why can't the manufacturer (Pfizer) help if you have Medicare?  Their paperwork for the co-pay help specifically says this. 

Thank you!

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Yes. Medicare co-pays for targeted therapy is absolutely bananas, more than most people pay for housing.  Medicare has rules about pharma co-pay assistance which frankly seems so unfair.  The best course of action is to speak to the social worker about how to obtain financial assistance. Most of my support group members were able to receive such support.  
 

If you are comfortable, pick up the phone and call your congressional representatives and demand action on the Cancer Drug Parity Bill which has been stalled.  Tell them how much your co-pay will be.  Targeted therapy should be reimbursed the same as chemotherapy and immunotherapy but since it’s a pill- the coverage is through Medicare Part D (when it should be Part B ).  The Medicare rules around this are so ridiculous. 
 

My husband took a part time job at UPS for Teamsters Coverage just to take care of my Alectinib co-pays.  We didn’t qualify for any of the financial assistance programs.  It’s maddening.  

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I'm thinking about coming off of SSDI just so I don't have to go on Medicare. 

We have private insurance that pays all of my targeted therapy, except for my deductible (which is an easy $500).  The premiums are expensive,  but I'd end up paying more if I roll over to Medicare. 

Thank you for letting me know about that bill. I had no idea there was one out there.

 

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Wyde,

I'd check with someone from Social Security on this. It looks to me like the only thing you're REQUIRED to take is Part A. If your private insurance is completely job-based, then I think you won't pay a penalty if you later want Part B. The main reason I'm forced to take Medicare is that my retirement-plan-paid insurance requires it.  But if your private insurance is truly private (and they don't require you to take Medicare when you're eligible), it seems to me you should be able to waive Part B and Part D, in favor of your private insurance. Sounds like it's certainly worth asking about.

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Yes, that’s correct, we waived the Medicare Part B & D however Medicare had rules about this in terms of the size of the employer.   It’s a good idea to check with Social Security or obtain a free consult from a disability attorney before making a final decision.  

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Our insurance is not employer-based. We brought it separately from a broker, because my husband was laid off and the company decided to only allow COBRA for a month.  I'll call my insurance company.

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5 hours ago, Wyde1340 said:

Our insurance is not employer-based. We brought it separately from a broker, because my husband was laid off and the company decided to only allow COBRA for a month.  I'll call my insurance company.

FWIW, your company has no say in COBRA. Do you mean they only decided to pay for a month?

Peace

Tom

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9 hours ago, Wyde1340 said:

Unfortunately,  they did. They shut down the refinery and went bankrupt.  

Well...damn. 

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