I am 68 and have been MGUS>Stage1 multiple myeloma>MGUS since 2008. My labs and BMBX have been pretty stable and I have not met criteria for therapy but with my blood analysis, the prognosis is that I will require therapy at some point. I expect sooner rather than later.
I have had Medicare and BC/BS health care through my retirement plan since I retired. Now my retirement plan is eliminating the BC/BS but will provide generous funding for the health care plan of my choice. My plan, at this point, is to choose a Medigap plan and a Part D drug plan.
Can anyone suggest a Part D plan that provides excellent coverage for Revlimid, and dexamethasone. I would like to minimize out of pocket costs. I will confirm that the Medigap plan covers Velcade. I believe I have sufficient resources that I will not require assistance from one of the many programs available.
I will appreciate any leads that would help me identify a plan with excellent coverage.
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8 posts
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chinook9 - Name: Brian
- Who do you know with myeloma?: Self
- When were you/they diagnosed?: MGUS 8/2008 SMM 6/2011
- Age at diagnosis: 65
Re: Part D drug plan recommendations + experiences?
Have you used the Medicare Plan Finder and entered in Revlimid and Dex into their analysis tool?
https://www.medicare.gov/find-a-plan/questions/home.aspx
https://www.medicare.gov/find-a-plan/questions/home.aspx
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Multibilly - Name: Multibilly
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: Smoldering, Nov, 2012
Re: Part D drug plan recommendations + experiences?
I will do this very shortly. I figured that there are detail that are learned from experience that probably are not covered by the tool. That, of course, remains to be seen.
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chinook9 - Name: Brian
- Who do you know with myeloma?: Self
- When were you/they diagnosed?: MGUS 8/2008 SMM 6/2011
- Age at diagnosis: 65
Re: Part D drug plan recommendations + experiences?
I live in S. Ca and I believe the Part D plans vary from area to area. I too like you had mgus at the time I had to choose a plan, not knowing what drugs I would be given if and when I needed. them.
I made multiple calls to many insurance companies and pharmacies and got no definitive answers. I called an oncology pharmacy nurse and ran a few plans by her. She recognized AARP United American as being an insurer she's worked with so I went with that. When I started treatment I was not given Revlimid or oral multiple myeloma meds so I've had no out of pocket multiple myeloma drug expenses(Part B Medicare and my medigap pays for IV drugs in full).
In researching plans I punch in Revlimid into the Medicare.gov site and all plans had the same bottom line of $10K/yr as my out of pocket costs without any subsidies for Revlimid. This year I changed plans and chose the cheapest Part D plan per month, knowing my drugs costs will be essentially the same since oral multiple myeloma drugs have such high costs.
I know this is not good news for you but I hope it helps.
I made multiple calls to many insurance companies and pharmacies and got no definitive answers. I called an oncology pharmacy nurse and ran a few plans by her. She recognized AARP United American as being an insurer she's worked with so I went with that. When I started treatment I was not given Revlimid or oral multiple myeloma meds so I've had no out of pocket multiple myeloma drug expenses(Part B Medicare and my medigap pays for IV drugs in full).
In researching plans I punch in Revlimid into the Medicare.gov site and all plans had the same bottom line of $10K/yr as my out of pocket costs without any subsidies for Revlimid. This year I changed plans and chose the cheapest Part D plan per month, knowing my drugs costs will be essentially the same since oral multiple myeloma drugs have such high costs.
I know this is not good news for you but I hope it helps.
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torimooney - Name: tori
- Who do you know with myeloma?: myself
- When were you/they diagnosed?: apr 2012
- Age at diagnosis: 64
Re: Part D drug plan recommendations + experiences?
Forgot to mention Dex is only $4/mo.Iit's been around a long time
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torimooney - Name: tori
- Who do you know with myeloma?: myself
- When were you/they diagnosed?: apr 2012
- Age at diagnosis: 64
Re: Part D drug plan recommendations + experiences?
When I was choosing my Medigap plan and part D plan I started with the online search through Medicare. When I had narrowed my choices down I then called the insurance companies to ask some basic questions. For part D I had decided on AARP United Healthcare, but they had 3 levels of membership and I couldn't see how one would be more advantageous than the other. I called the insurance company and asked the representative to help me decide which would be the best plan for me. Once she heard that I was taking Revlimid she said that the least expensive plan would be fine for me because the cost of the Revlimid would put me into the catastrophic level of payment and meet my annual deductible in the first month.
I have been very happy with the AARP plan. Their mail order pharmacy and their specialty pharmacy are very efficient and easy to deal with. The specialty pharmacy notifies my oncologist every month when it is time for a new prescription and then calls me to set up a delivery date for the Revlimid. It has always arrived when we planned for it to arrive. The regular mail order pharmacy always lets me know when it is time to reorder my prescriptions and when I need to get a new prescription for any of my drugs.
I also chose the AARP United Healthcare medigap plan. The one I chose covers all my expenses even if the doctor or facility I use doesn't accept Medicare assignment. I don't have any copays for doctor visits, etc. I chose this so I know what my medical expenses will be every month instead of worrying about having multiple copays that I didn't expect in any month. Again, I have been very pleased with the coverage and it has more than paid for itself in the 7 months of 2013 that I had it.
Having to figure out all of this insurance coverage stuff is a full time job. I spent so much time reading things, going to seminars about it for cancer patients, going on line, talking to insurance reps, etc to make the best decision for me that I could. Good luck in doing your research and deciding on what works best for you.
Nancy in Phila
I have been very happy with the AARP plan. Their mail order pharmacy and their specialty pharmacy are very efficient and easy to deal with. The specialty pharmacy notifies my oncologist every month when it is time for a new prescription and then calls me to set up a delivery date for the Revlimid. It has always arrived when we planned for it to arrive. The regular mail order pharmacy always lets me know when it is time to reorder my prescriptions and when I need to get a new prescription for any of my drugs.
I also chose the AARP United Healthcare medigap plan. The one I chose covers all my expenses even if the doctor or facility I use doesn't accept Medicare assignment. I don't have any copays for doctor visits, etc. I chose this so I know what my medical expenses will be every month instead of worrying about having multiple copays that I didn't expect in any month. Again, I have been very pleased with the coverage and it has more than paid for itself in the 7 months of 2013 that I had it.
Having to figure out all of this insurance coverage stuff is a full time job. I spent so much time reading things, going to seminars about it for cancer patients, going on line, talking to insurance reps, etc to make the best decision for me that I could. Good luck in doing your research and deciding on what works best for you.
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: Part D drug plan recommendations + experiences?
I selected Humana as my grandmother's Part D coverage and, so far, it has covered all her prescription drugs, including her Revlimid with no co-pay. The coverage is only a few months old but, so far, I have not had any issues at all and I pretty much fill and refill prescriptions on a weekly basis, not just for her myeloma but also for other preexisting conditions.
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BlueSunshine - Name: Sunny
- Who do you know with myeloma?: Grandmother
- When were you/they diagnosed?: 2014
- Age at diagnosis: 69
Re: Part D drug plan recommendations + experiences?
BlueSunshine,
According my recent research, Humana has 3 plans. Which of the plans is you grandmother on?
According my recent research, Humana has 3 plans. Which of the plans is you grandmother on?
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chinook9 - Name: Brian
- Who do you know with myeloma?: Self
- When were you/they diagnosed?: MGUS 8/2008 SMM 6/2011
- Age at diagnosis: 65
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