My son has multiple myeloma. Been treated with Revlimid. Now it's not working. Doctor wants to put him on CyBorD (cyclophosphamide + Velcade + dexamethasone) starting next week. Medicare and supplement both say they do not cover this?
Has anyone been treated with this chemo and had Medicare cover it?
Thanks,
Jack
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Re: Medicare coverage of CyBorD / VCD
I am taking Velcade and dex right now and it is all covered by Medicare. My doctor may add cyclophosphamide later and I've been advised that it will be covered also.
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Sheila526300
Re: Medicare coverage of CyBorD / VCD
Hi Jack,
Are you in Australia and talking about the Australian Medicare? If so, there does seem to be some complicated rules about what treatments are covered (I think it's the Pharmaceutical Benefits Scheme more than Medicare) depending on what you had before – e.g. immunomodulator (thalidomide or Revlimid) or proteasome inhibitor (bortezomib / Velcade) – and what your results have been.
I was started on CDT (cyclophosphamide, dexamethasone, thalidomide) in 2011 and had a stem cell transplant soon after . It was successful, but just now my paraprotein is creeping back up and my doctor is going to put me on CyBorD, which will be covered.
If I were you, I'd get a second opinion from another haematologist. It seems sometimes the way they present the story and results affects whether you will be covered.
Good luck,
Peter
Are you in Australia and talking about the Australian Medicare? If so, there does seem to be some complicated rules about what treatments are covered (I think it's the Pharmaceutical Benefits Scheme more than Medicare) depending on what you had before – e.g. immunomodulator (thalidomide or Revlimid) or proteasome inhibitor (bortezomib / Velcade) – and what your results have been.
I was started on CDT (cyclophosphamide, dexamethasone, thalidomide) in 2011 and had a stem cell transplant soon after . It was successful, but just now my paraprotein is creeping back up and my doctor is going to put me on CyBorD, which will be covered.
If I were you, I'd get a second opinion from another haematologist. It seems sometimes the way they present the story and results affects whether you will be covered.
Good luck,
Peter
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PeterSydney - Name: Peter Mansfield
- Who do you know with myeloma?: myself
- When were you/they diagnosed?: 2011
- Age at diagnosis: 45
Re: Medicare coverage of CyBorD / VCD
Jack,
I am by no means a Medicare expert and I'm not currently on Medicare myself, but are you sure about this denial? On page 50 of the 2014 NCCN guidelines for multiple myeloma, CyBorD (cyclophosamide/bortezomib/dexamethasone) is listed as a treatment regimen for previously treated multiple myeloma patients. To find this document, see:
"Medicare Expands Coverage Of Off-Label Uses Of Cancer Drugs – Part 2: Medicare-Approved Compendia," The Myeloma Beacon, Apr 1, 2009.
My understanding is that Medicare refers to the the NCCN document as one of their compendia to help determine which drugs they will support for a given stage of a disease. So, you and your doc might have some good ammo to challenge Medicare if they don't at first approve the use of CyBorD. I know that approved Part D drugs can vary from insurance carrier to carrier, so coverage of a given drug may indeed be an issue with your particular Part D provider (you can always switch Medigap plans, but I believe there are waiting periods for newer coverage if you do make a switch, as well as a host of other rules surrounding when you can actually make the switch; see this information for further details).
I don't pretend to understand how the three components of CyBorD coverage is split up between Part B and Part D of any person's given insurance.
Lastly, did you refer to this cocktail by its abbreviation (CyBord or VCD) or by the individual drugs that make up that cocktail (cyclophosphamide / bortezomib / dexamethasone) when you were making your inquiry?
I am by no means a Medicare expert and I'm not currently on Medicare myself, but are you sure about this denial? On page 50 of the 2014 NCCN guidelines for multiple myeloma, CyBorD (cyclophosamide/bortezomib/dexamethasone) is listed as a treatment regimen for previously treated multiple myeloma patients. To find this document, see:
"Medicare Expands Coverage Of Off-Label Uses Of Cancer Drugs – Part 2: Medicare-Approved Compendia," The Myeloma Beacon, Apr 1, 2009.
My understanding is that Medicare refers to the the NCCN document as one of their compendia to help determine which drugs they will support for a given stage of a disease. So, you and your doc might have some good ammo to challenge Medicare if they don't at first approve the use of CyBorD. I know that approved Part D drugs can vary from insurance carrier to carrier, so coverage of a given drug may indeed be an issue with your particular Part D provider (you can always switch Medigap plans, but I believe there are waiting periods for newer coverage if you do make a switch, as well as a host of other rules surrounding when you can actually make the switch; see this information for further details).
I don't pretend to understand how the three components of CyBorD coverage is split up between Part B and Part D of any person's given insurance.
Lastly, did you refer to this cocktail by its abbreviation (CyBord or VCD) or by the individual drugs that make up that cocktail (cyclophosphamide / bortezomib / dexamethasone) when you were making your inquiry?
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Multibilly - Name: Multibilly
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: Smoldering, Nov, 2012
Re: Medicare coverage of CyBorD / VCD
I was on cyclophosphamide for a couple months until my oncologist took me off of it as it was not working for me. Initially my part D prescription coverage denied the drug. It was costing $300.00 a month. The good news is that the drug is indeed fully covered through medicare part B not part D. I was able to get full reimbursement back.
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bluefire - Who do you know with myeloma?: Self
- When were you/they diagnosed?: Nov. 2014
- Age at diagnosis: 59
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