My husband (age 74) is on Revlimid 10 mg. The 21 day supply cost is $7,700.00.
Assistance from the Chronic Disease Fund is based on the patient's AGI from the prior year's Income Tax Return. The AGI must be $55,000, or less, to receive CDF assistance.
The CDF is great. Hopefully they'll continue to have funds to provide assistance to those of us, in need.
Forums
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Sarah - Name: Sarah
- Who do you know with myeloma?: Husband
- When were you/they diagnosed?: October 7, 2010
- Age at diagnosis: 72
Re: Medicare coverage of Revlimid
i was told i may need this treament my income is around 33000 yearly so my cost would be $6900 every 2 weeks does not leave much to live on so i i taket it wont be around long thanks to all the help medicare (they had no problem taking money out of my pay when i was working!)
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joe
Re: Medicare coverage of Revlimid
Also, try the Leukemia and Lymphoma Society for financial help. They have pretty liberal income rules.
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zephyrus - Name: Lee
- Who do you know with myeloma?: wife
- When were you/they diagnosed?: Feb, 2012
- Age at diagnosis: 64
Re: Medicare coverage of Revlimid
Our doctor's practitioner nurse told us that Florida Cancer Specialists has a pharmacist in Ft. Myers who calls ahead to Medicare and has gotten approval for Plan B with Revlimid. We were amazed! Congress has a bill currently to mull it over.
Martha Wunsch
Martha Wunsch
Re: Medicare coverage of Revlimid
Looking at this post I see that all comments are from 2012. During a phone conversation I had yesterday with the Celgene Financial Support Coordinator, I was told that Medicare would cover Revlimid Maintenance. Does anyone have any first had experience with this and is this true?
Thanks,
Thanks,
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Pjorg45 - Name: Paul Jorgensen
- When were you/they diagnosed?: May 1013
- Age at diagnosis: 68
Re: Medicare coverage of Revlimid
Hi,
I just started Medicare a couple of months ago and have the AARP part D plan and live in Texas. The plan covers Revlimid but it requires approval.
I've been on Revlimid for over 2 years but just switched to Medicare. My work insurance co-pay was $40. My first Medicare Part D co-pay for Revlimid was $3,000 and my second was $240, which I believe will stay around the same for the rest of the year.
With Part D plans, you need to make sure all your drugs are covered, as each plan covers different drugs at different levels. The reason for the first really high payment is because I was in the prescription gap. For me my Revlimid was the number 1 priority with my Part-D.
When I selected my Part D plan, I used the AARP website to both see what was covered and what my total out-of-pocket this year would be. You enter your list of drugs and it shows you the cost and level for each of your drugs and your total out-of -pocket for each plan. My total prescription out-of-pocket for my plan is ~$8000 a year with my Part D plan. All of the Part D providers along with the Medicare site provide this information IIRC.
The level of Revlimid always requires pre-approval as far as I could see in the plans available to me in Texas that covered Revlimid.
If I didn't have the Part D plan, my cost would have be closer to $60,000, as far as I understand it, unless I left the US for treatment.
Cheers.
I just started Medicare a couple of months ago and have the AARP part D plan and live in Texas. The plan covers Revlimid but it requires approval.
I've been on Revlimid for over 2 years but just switched to Medicare. My work insurance co-pay was $40. My first Medicare Part D co-pay for Revlimid was $3,000 and my second was $240, which I believe will stay around the same for the rest of the year.
With Part D plans, you need to make sure all your drugs are covered, as each plan covers different drugs at different levels. The reason for the first really high payment is because I was in the prescription gap. For me my Revlimid was the number 1 priority with my Part-D.
When I selected my Part D plan, I used the AARP website to both see what was covered and what my total out-of-pocket this year would be. You enter your list of drugs and it shows you the cost and level for each of your drugs and your total out-of -pocket for each plan. My total prescription out-of-pocket for my plan is ~$8000 a year with my Part D plan. All of the Part D providers along with the Medicare site provide this information IIRC.
The level of Revlimid always requires pre-approval as far as I could see in the plans available to me in Texas that covered Revlimid.
If I didn't have the Part D plan, my cost would have be closer to $60,000, as far as I understand it, unless I left the US for treatment.
Cheers.
Re: Medicare coverage of Revlimid
When selecting a part D plan call the insurance companies and talk with them about their coverage. I had decided to go with the AARP plans that are available in the Philadelphia region, but there are 3 levels of subscription cost. I called to find out if there was an advantage to subscribing to the more expensive level because I couldn't tell by the information that was provided on line. The person I spoke with told me that with the cost of Revlimid putting me into the catastrophic level of drug coverage within one month, that there was no advantage to subscribing to the more expensive levels of coverage. In fact my overall costs for the year would be less by subscribing to their least expensive plan which is $15 per month.
The first month of Revlimid was billed to me at around $3600 because it was in my first month of coverage. Since then it has been billed at around $400 a month. Paying this amount each month was going to deplete my emergency savings for the year so I applied for help with funding. The Chronic Disease Fund approved my application. It has been a very smooth process reordering Revlimid each month and the specialty pharmacy billing the CDF for the cost of the prescription.
I must also mention that my experience with the specialty pharmacy that is used by my AARP plan, OptumRx, has been stellar so far. When I told them that I had a grant to pay for my prescription they asked for my ID and looked it up immediately. Each month they have just said that they would bill CDF for the refill without my saying anything. My deliveries have been right when they said that they would arrive. I'm very pleased with my experience with OptumRx for the Revlimid prescription and with all of my other mail order prescriptions.
Bottom line is that you need to do your research when beginning with Medicare. Make sure that you select a supplemental insurance plan that will truly cover most of your costs for cancer treatment. Remember that Medicare only pays 80% of costs and then you are responsible for the 20%. The various supplemental plans will cover from 50% to 100% of that remaining 20% that Medicare doesn't cover. If you are receiving chemo at the doctor's office, that 20% could be hundreds of dollars a treatment. Even though I am paying more up front for my supplemental plan, it covers at the highest level and means that I don't have to worry about bills that I can't afford each month. If you are looking at an Advantage plan be sure to read the fine print about cancer care. Many of them have limits as to how much they will cover and then you are responsible for the rest. Again, that could be hundreds of dollars out of pocket that you didn't plan on.
Nancy in Phila
The first month of Revlimid was billed to me at around $3600 because it was in my first month of coverage. Since then it has been billed at around $400 a month. Paying this amount each month was going to deplete my emergency savings for the year so I applied for help with funding. The Chronic Disease Fund approved my application. It has been a very smooth process reordering Revlimid each month and the specialty pharmacy billing the CDF for the cost of the prescription.
I must also mention that my experience with the specialty pharmacy that is used by my AARP plan, OptumRx, has been stellar so far. When I told them that I had a grant to pay for my prescription they asked for my ID and looked it up immediately. Each month they have just said that they would bill CDF for the refill without my saying anything. My deliveries have been right when they said that they would arrive. I'm very pleased with my experience with OptumRx for the Revlimid prescription and with all of my other mail order prescriptions.
Bottom line is that you need to do your research when beginning with Medicare. Make sure that you select a supplemental insurance plan that will truly cover most of your costs for cancer treatment. Remember that Medicare only pays 80% of costs and then you are responsible for the 20%. The various supplemental plans will cover from 50% to 100% of that remaining 20% that Medicare doesn't cover. If you are receiving chemo at the doctor's office, that 20% could be hundreds of dollars a treatment. Even though I am paying more up front for my supplemental plan, it covers at the highest level and means that I don't have to worry about bills that I can't afford each month. If you are looking at an Advantage plan be sure to read the fine print about cancer care. Many of them have limits as to how much they will cover and then you are responsible for the rest. Again, that could be hundreds of dollars out of pocket that you didn't plan on.
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: Medicare coverage of Revlimid
Several posts have talked about state legislation that treats Revlimid the same way that medicare must pay for intravenous chemo. Does anyone know which states have passed this legislation? Also congress has a bill to deal with the outlandish costs of Revlimid. Does anyone know the bill number?
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rickl - Name: Richard Levine
- When were you/they diagnosed?: 2011
- Age at diagnosis: 68
Re: Medicare coverage of Revlimid
Rickl -
Unfortunately, the state legislations don't apply to Medicare in their parity acts, only private insurances. Any change in Medicare coverage has to come through Federal legislation. There has been a bill submitted, but I don't remember the number. You can contact the IMF about all of the bills that have been submitted at various levels. The previous post gives their website.
Nancy in Phila
Unfortunately, the state legislations don't apply to Medicare in their parity acts, only private insurances. Any change in Medicare coverage has to come through Federal legislation. There has been a bill submitted, but I don't remember the number. You can contact the IMF about all of the bills that have been submitted at various levels. The previous post gives their website.
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: Medicare coverage of Revlimid
I was diagnosed with multiple myeloma in November 2014. When I found out the cost of the Revlimid, I went ballistic.
I couldn't get a straight answer as to the cost from either Walgreen Specialty Pharmacy (WSP), which is where it was being shipped from, or my Medicare Advantage program with SummaCare in Summit County (Akron, OH) area. I was quoted initial figures of $10,000 per cycle and then after insurance $2850 per cycle, which I immediately translated into about $35k per year.
I then started talking about physician assisted suicide as I was not going to bankrupt my wife just to get a couple more years of life. I'm 72 and have had a very good life with 4 wonderful self-sufficient children.
Well, then the WSP person said I wouldn't have to do that, she'll put me in for a PAP (Patient Assistance Program). All she had to do was get some personal information from me, submit it, and I was approved in less than 10 minutes. The criteria were that I could not be earning more than 5 times the government poverty level, which is around $15k. That translates into about $75k earnings. No problem for us.
The amount of the PAP was $10,000 for one year. So, with that, they took the $2850 first payment out of the $10k and along with some other drugs I get for my emphysema, I went in and out of the "donut hole" all at once in January. After that, with my Medicare Advantage program, the monthly cost for the Revlimid dropped to about $475, so I was golden for the rest of the year.
Also in December I was directed to the Leukemia and Lymphoma Society, as they also have a PAP program for multiple myeloma patients, so I qualified for another $10k there also. So all the multiple myeloma meds I'm on over and above the Revlimid can now be submitted to that PAP. I think they also said it would pay the $100+ Medicare Part B cost that is automatically deducted from my monthly Social Security check.
In discussions with both parties I was told that these PAPs are usually renewable each year. I'll start that process in November just to be sure.
Hope this helps some of the rest of you as this information is usually not forthcoming unless you start pushing some buttons -- like threatening suicide as I did.
Best of health to you all.
Richard Lash, aka Mr. Numbers
I couldn't get a straight answer as to the cost from either Walgreen Specialty Pharmacy (WSP), which is where it was being shipped from, or my Medicare Advantage program with SummaCare in Summit County (Akron, OH) area. I was quoted initial figures of $10,000 per cycle and then after insurance $2850 per cycle, which I immediately translated into about $35k per year.
I then started talking about physician assisted suicide as I was not going to bankrupt my wife just to get a couple more years of life. I'm 72 and have had a very good life with 4 wonderful self-sufficient children.
Well, then the WSP person said I wouldn't have to do that, she'll put me in for a PAP (Patient Assistance Program). All she had to do was get some personal information from me, submit it, and I was approved in less than 10 minutes. The criteria were that I could not be earning more than 5 times the government poverty level, which is around $15k. That translates into about $75k earnings. No problem for us.
The amount of the PAP was $10,000 for one year. So, with that, they took the $2850 first payment out of the $10k and along with some other drugs I get for my emphysema, I went in and out of the "donut hole" all at once in January. After that, with my Medicare Advantage program, the monthly cost for the Revlimid dropped to about $475, so I was golden for the rest of the year.
Also in December I was directed to the Leukemia and Lymphoma Society, as they also have a PAP program for multiple myeloma patients, so I qualified for another $10k there also. So all the multiple myeloma meds I'm on over and above the Revlimid can now be submitted to that PAP. I think they also said it would pay the $100+ Medicare Part B cost that is automatically deducted from my monthly Social Security check.
In discussions with both parties I was told that these PAPs are usually renewable each year. I'll start that process in November just to be sure.
Hope this helps some of the rest of you as this information is usually not forthcoming unless you start pushing some buttons -- like threatening suicide as I did.
Best of health to you all.
Richard Lash, aka Mr. Numbers
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