I am still sitting down. Just had my treatment changed from Revlimid, Velcade, and dexamethasone to Pomalyst, Velcade and dex. Ok, that's fine, but just called my Medicare / insurance advisor to see if it's covered. I will be 65 in July and just need to know my costs up front. She told me that Humana says its $18,000 per prescription.
What? Are you kidding, is what I said. I looked myself on Humana and sure enough it's showing that drug at around $17,900. But I look at the Celgene pricing and I am finding prices around $10,500.
So here's my question. Is there some recent mark up from Celgene or is this a way for Humana to make money overpricing this drug? I just recently received some assistance from PAN for around $12 500. My out of pocket would be $900.00 per month not to mention the amount to get out of the donut hole.
Please, could someone enlighten me on this ?
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Castaway - Name: George
- Who do you know with myeloma?: just myself
- When were you/they diagnosed?: 1/24/14
- Age at diagnosis: 62
Re: Humana charge for Pomalyst
Unfortunately, that sounds about right for the list price of Pomalyst in 2016. You can use this Medicare Part D drug calculator to check your specifics:
https://q1medicare.com/PartD-2016-SearchPDPMedicareDrugFinder.php?utm_source=partd&utm_medium=jumplink&utm_campaign=header
Every provider's list price for Pomalyst is in the $17k-$18K/month range in 2016. At the catastrophic 5% Medicare Part D payment level after you exit the donut hole, that would indeed be about $900/month.
But Revlimid isn't much better at about $15K/month in 2016. And Ninlaro isn't too far behind that price.
It is truly obscene that Medicare is prohibited from negotiating drug prices and that pill pricing is treated differently than IV drug pricing for cancer treatment.
https://q1medicare.com/PartD-2016-SearchPDPMedicareDrugFinder.php?utm_source=partd&utm_medium=jumplink&utm_campaign=header
Every provider's list price for Pomalyst is in the $17k-$18K/month range in 2016. At the catastrophic 5% Medicare Part D payment level after you exit the donut hole, that would indeed be about $900/month.
But Revlimid isn't much better at about $15K/month in 2016. And Ninlaro isn't too far behind that price.
It is truly obscene that Medicare is prohibited from negotiating drug prices and that pill pricing is treated differently than IV drug pricing for cancer treatment.
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Multibilly - Name: Multibilly
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: Smoldering, Nov, 2012
Re: Humana charge for Pomalyst
Multibilly,
Thank you for the reply. Currently I am on my wife's insurance. It has been paying well for the Revlimid. My co-pay is $50.00. We have Express Scripts and it shows cost for Revlimid at around $10,500 on my last statement. Possibly going up to $11,000.
Unfortunately my wife has had surgery and complications. So we are about to go on COBRA. But I can not be on COBRA if Medicare is a available to me. So it's Medicare for me.
I guess what bothers me most is that I have read some info on Celgene and their projected pricing for Pomalyst was around $11,000.
How does Humana use a cost figure of $18,000? When Celgene had said about $11,000. Was that just pulled out of the sky? How did Humana inflate the cost so high?
We all have a cancer to deal with that brings a lot of issues along with it. So much to deal with and this kind of cost abuse shouldn't be part of that.
Time to look for additional assistance.
Thank you for the reply. Currently I am on my wife's insurance. It has been paying well for the Revlimid. My co-pay is $50.00. We have Express Scripts and it shows cost for Revlimid at around $10,500 on my last statement. Possibly going up to $11,000.
Unfortunately my wife has had surgery and complications. So we are about to go on COBRA. But I can not be on COBRA if Medicare is a available to me. So it's Medicare for me.
I guess what bothers me most is that I have read some info on Celgene and their projected pricing for Pomalyst was around $11,000.
How does Humana use a cost figure of $18,000? When Celgene had said about $11,000. Was that just pulled out of the sky? How did Humana inflate the cost so high?
We all have a cancer to deal with that brings a lot of issues along with it. So much to deal with and this kind of cost abuse shouldn't be part of that.
Time to look for additional assistance.
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Castaway - Name: George
- Who do you know with myeloma?: just myself
- When were you/they diagnosed?: 1/24/14
- Age at diagnosis: 62
Re: Humana charge for Pomalyst
Ask your doctor's office about putting you in touch with Celgene's patient assistance team. They may well be able to help with insurance coverage, size of co-pay and, when necessary, expediting shipments of the Pomalyst.
Best of luck to you.
Best of luck to you.
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philatour - Who do you know with myeloma?: spouse
Re: Humana charge for Pomalyst
Philatour,
Thank you for the info. I actually called Acreedo Specialty Pharmacy, which is the company that distributes the Revlimid that I was taking and now my Pomalyst. It is shipped to my oncologist and they sign for it. That way I don't have to be home waiting for it to be delivered and sign for it. Acreedo is with Express Scripts. I did receive a fund assistance, which Acreedo helped me get at Patient Access Network (PAN) for $12,500.
With the donut hole amount and the $900 co-pay per prescription, that will go very fast. So I called PAN this morning. They explained that the donut hole amount will come out of that money and then the $900 will also come out every prescription. When the $12,500 allowance gets to 75% used, they will reassess my need for the drugs, and then if needed, another grant will be set aside for another $12,500. Only if there is the funding for it through PAN. If not they will look at other options.
I feel a little better about this but still upset at the cost for these drugs. Especially now not having commercial insurance when I hit 65.
George
Thank you for the info. I actually called Acreedo Specialty Pharmacy, which is the company that distributes the Revlimid that I was taking and now my Pomalyst. It is shipped to my oncologist and they sign for it. That way I don't have to be home waiting for it to be delivered and sign for it. Acreedo is with Express Scripts. I did receive a fund assistance, which Acreedo helped me get at Patient Access Network (PAN) for $12,500.
With the donut hole amount and the $900 co-pay per prescription, that will go very fast. So I called PAN this morning. They explained that the donut hole amount will come out of that money and then the $900 will also come out every prescription. When the $12,500 allowance gets to 75% used, they will reassess my need for the drugs, and then if needed, another grant will be set aside for another $12,500. Only if there is the funding for it through PAN. If not they will look at other options.
I feel a little better about this but still upset at the cost for these drugs. Especially now not having commercial insurance when I hit 65.
George
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Castaway - Name: George
- Who do you know with myeloma?: just myself
- When were you/they diagnosed?: 1/24/14
- Age at diagnosis: 62
Re: Humana charge for Pomalyst
George-
You've already done most of what I would suggest that you do.
To clarify some of the information that you've received about part D. Your first prescription of Pomalyst that you fill with part D will be whatever percentage of the total cost that Medicare pays when you are in the first phase of prescription payment. This will meet your maximum for both the first phase and the donut hole. Your 2nd prescription and all others until the end of the year will be covered in the catastrophic phase of payment, $900 for Pomalyst. Any other medication that you are prescribed after that first Pomalyst prescription will also be covered at the catastrophic level. So, wait until the Pomalyst is filled before filling, or refilling, any other prescription drug you take. Then, January 1, 2017 you will have to pay the cost of the first prescription of Pomalyst at the phase 1 level again.
I don't know what the rules of PAN are about applying for other financial grants. I have 2 different grants that cover the costs of both Revlimid and my medical insurances. If PAN doesn't give you another grant when the current one is depleted, you could apply for one from the LLS or from the Chronic Disease Fund. All of them respond quickly once the application is submitted.
All of this requires so much work to keep straight. Having myeloma can be a full-time job some times trying to keep all of the rules and regulations of the various insurances straight.
All the best,
Nancy in Phila
You've already done most of what I would suggest that you do.
To clarify some of the information that you've received about part D. Your first prescription of Pomalyst that you fill with part D will be whatever percentage of the total cost that Medicare pays when you are in the first phase of prescription payment. This will meet your maximum for both the first phase and the donut hole. Your 2nd prescription and all others until the end of the year will be covered in the catastrophic phase of payment, $900 for Pomalyst. Any other medication that you are prescribed after that first Pomalyst prescription will also be covered at the catastrophic level. So, wait until the Pomalyst is filled before filling, or refilling, any other prescription drug you take. Then, January 1, 2017 you will have to pay the cost of the first prescription of Pomalyst at the phase 1 level again.
I don't know what the rules of PAN are about applying for other financial grants. I have 2 different grants that cover the costs of both Revlimid and my medical insurances. If PAN doesn't give you another grant when the current one is depleted, you could apply for one from the LLS or from the Chronic Disease Fund. All of them respond quickly once the application is submitted.
All of this requires so much work to keep straight. Having myeloma can be a full-time job some times trying to keep all of the rules and regulations of the various insurances straight.
All the best,
Nancy in Phila
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NStewart - Name: Nancy Stewart
- Who do you know with myeloma?: self
- When were you/they diagnosed?: 3/08
- Age at diagnosis: 60
Re: Humana charge for Pomalyst
Nancy,
Thank you for the information. It does take a lot of organizing and filing to keep it straight, as you said. I also have been helping my wife out after she had neurosurgery. Setting up her state disability and organizing / filing all her procedures and treatments. I can't tell you how many times I had to refer to those files for her information. Same for all my multiple myeloma files.
It's interesting that you have one grant to help with the medical insurance. I will look into that also. At times I forget about the multiple myeloma I have because of all the work that's involved related to it.
Thank you, George
Thank you for the information. It does take a lot of organizing and filing to keep it straight, as you said. I also have been helping my wife out after she had neurosurgery. Setting up her state disability and organizing / filing all her procedures and treatments. I can't tell you how many times I had to refer to those files for her information. Same for all my multiple myeloma files.
It's interesting that you have one grant to help with the medical insurance. I will look into that also. At times I forget about the multiple myeloma I have because of all the work that's involved related to it.
Thank you, George
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Castaway - Name: George
- Who do you know with myeloma?: just myself
- When were you/they diagnosed?: 1/24/14
- Age at diagnosis: 62
Re: Humana charge for Pomalyst
The Chronic Disease Fund no longer supports multiple myeloma (for new applicants).
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pariha
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