[ThisniCaza]

Medicare coverage of Zometa?

by ThisniCaza on Thu Mar 22, 2018 7:17 pm

I started Zometa, every three weeks, in December. I was told a few weeks ago by my cancer center's business office that beginning last fall (fall 2017) Zometa was no longer approved by Medicare for use in patients who have multiple myeloma.

The business office helped me apply for assistance. I was told I did not qualify because my co-pay would not be more than 10% of my income. I kinda lost it and said (paraphrasing), "What co-pay? I was plain ol' denied."

I was a bit surprised that the drug company didn't know about the denial, and that I hadn't found anything online about this reversal in approvals. I keep hoping my doctor's office made a mistake in coding or something.

Is it true that Medicare now doesn't cover Zometa? Is there any way to get it covered through a doctor request, or something similar?

Thanks in advance!

[Kkatzmmeow]

Re: Medicare coverage of Zometa?

by Kkatzmmeow on Fri Mar 23, 2018 11:01 pm

I went to the medicare.gov website and checked in my area. It doesn't appear that Zometa is covered. However, there is a generic, zoledronic acid, and that is covered. Perhaps ask your doctor if that is acceptable.

[Nancy Shamanna]

Re: Medicare coverage of Zometa?

by Nancy Shamanna on Sat Mar 24, 2018 9:26 am

Hello Thisni Caza,

Zolendroic acid is the scientific name for Zometa. If you are getting a generic version of the brand name drug, it should be the same formulation. In my treatments I have taken many generic drugs, e.g., dexamethasone (Decadron), apo-anastrazole, (an aromatase inhibitor), pamidronate (Aredia). Definitely ask your oncologist about this though.