Forums
Re: Medicare coverage of Revlimid
My dad is in a skilled nursing facility covered by Medicare Part A. He has been on Revlimid previously but now needs to restart. The skilled nursing facility says it is too expensive and Medicare does not cover it, so they refuse to give it even though it has been prescribed. They also won't let us bring in the medication even if my parents pay for it. Now they are kicking him out because he is not improving (maybe because his cancer isn't being treated?). Can anyone give us advice?
Re: Medicare coverage of Revlimid
Hi Nancy,
I realize that every patient's needs are different and there are variations in Medicare rules and policies from state to state. But would you mind sharing just which of the standardized Medicare supplement plans you ended up choosing?
I realize that every patient's needs are different and there are variations in Medicare rules and policies from state to state. But would you mind sharing just which of the standardized Medicare supplement plans you ended up choosing?
-
Multibilly - Name: Multibilly
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: Smoldering, Nov, 2012
Re: Medicare coverage of Revlimid
My oncologist strongly recommends Revlimid for my next treatment regimen. The induction therapy has stopped working. I had five rounds of cyclophosphamide, Velcade, and dexamethasone (CyBorD) since August 2016.
Needless to say, I cannot to pay for the Revlimid myself. I am also on Medicare with AARP gap insurance. Everything is covered except the oral tier 5 meds, most of which are life-saving cancer drugs. Celgene is also working with me, but it doesn't look promising. If the cost doesn't come down, my oncologist will try another therapy which will have to be infused and is fully covered .
Kris
Needless to say, I cannot to pay for the Revlimid myself. I am also on Medicare with AARP gap insurance. Everything is covered except the oral tier 5 meds, most of which are life-saving cancer drugs. Celgene is also working with me, but it doesn't look promising. If the cost doesn't come down, my oncologist will try another therapy which will have to be infused and is fully covered .
Kris
Re: Medicare coverage of Revlimid
Revlimid and other "oral" cancer drugs are covered under Part D of Medicare. Those drugs that are administered in a doctor's office or infusion clinic are covered under Part B of Medicare. Most Medicare patients pay a monthly premium for the Part B coverage and get a supplemental plan to cover co-pays and deductibles. Thus, those who have a full supplemental plan (like Plan F) will only owe their Medicare premium for any infusions or shots administered under Part B.
Part D is a different story. Generally a patient has to be out of pocket $5,000 (exclusive of premiums) before the "catastrophic" coverage portion kicks in. The catastrophic coverage is 95% of any future annual expenses, with the patient responsible for the other 5%. Currently there is no cap on the 5%. A 21 day supply of 10 mg of Revlimid runs about $13,000 per month or an annual cost of about $156,000. Generally, given the price of Revlimid, the total annual patient out-of-pocket of $5,000 will be met in the first month, so the catastrophic coverage will kick in starting in the second month. Assuming a full year of treatment, the max out of pocket (not including premium payments) would be $12,150. Many patients based upon income may be able to obtain assistance from Celgene which could reduce the total out of pocket cost.
Part D is a different story. Generally a patient has to be out of pocket $5,000 (exclusive of premiums) before the "catastrophic" coverage portion kicks in. The catastrophic coverage is 95% of any future annual expenses, with the patient responsible for the other 5%. Currently there is no cap on the 5%. A 21 day supply of 10 mg of Revlimid runs about $13,000 per month or an annual cost of about $156,000. Generally, given the price of Revlimid, the total annual patient out-of-pocket of $5,000 will be met in the first month, so the catastrophic coverage will kick in starting in the second month. Assuming a full year of treatment, the max out of pocket (not including premium payments) would be $12,150. Many patients based upon income may be able to obtain assistance from Celgene which could reduce the total out of pocket cost.
-
Ron Harvot - Name: Ron Harvot
- Who do you know with myeloma?: Myself
- When were you/they diagnosed?: Feb 2009
- Age at diagnosis: 56
34 posts
• Page 4 of 4 • 1, 2, 3, 4
Return to Insurance & Patient Assistance Programs