I finally made the big decision…
“Worth its weight in gold” takes on new meaning for me. I’ve
written about the new super expensive cancer drugs several times. Now I've
joined the club. The whole process has been very educational. My drug is
abiraterone (Zytiga), but the numbers are similar for many other drugs for
numerous cancers.
I discovered that drug companies, charitable organizations, and
Medicare Extra Help offer financial assistance for those with no drug coverage insurance
or the very high co-pays some drugs require. My oncology clinic helped me fill
out forms and apply to the various possible organizations. The whole process
was slow. My PSA had doubled, doubled again, and doubled yet again in the past
year. So, I was slightly motivated to do something different and after six
weeks of waiting I decided to go ahead and do it myself.
I am on a MedAdvantage plan that includes Medicare Part D. The
exact co-pay will depend on which plan you have so rather than list specific
dollar amounts that may not be the same for you, I’ll share my experience
process. Part D has three levels, the first being your insurance company’s regular
co-pay (29% of the total drug cost in my case). At a certain dollar level you
enter the donut hole in which patients originally would pay 100%, but thanks to
the Affordable Care Act, Medicare has a Coverage Gap Discount Program. If the
drug company that makes your medication participates in the program (99% do)
what you pay varies from 47.5% for brand name drugs to 79% for generics. Then
there is the Catastrophic Coverage where patients have a small co-pay or
coinsurance (I pay a 5% coinsurance) for the remainder of the calendar year.
My first prescription took me through all three levels, so
my next refills will be in the 5% category. Then in January the party starts
all over again. Thank you Part D.
Will an expensive drug work better than a much, much cheaper
generic? Nobody knows for sure, and right now there no generics for most of
these drugs. Watch this space every month for my latest PSA and blood panel information.
If the drug lowers my PSA, helps me lose weight, and grows hair, the cost will
seem worthwhile.
I can’t help thinking about those people who don’t have drug
insurance coverage and have to come up with five figure co-pays every month. Most
people can’t afford that. This can be the case with a lot of drugs for a lot of
cancers. I consider myself fortunate, even though I groan and complain about
the costs. It was good to find that there is help ‘out there.’ So do your
homework, talk to doctors, nurses, your insurance company, the drug company
that manufactures your meds, and your friends who have gone through the
process. Don’t assume you can’t afford a drug until you check out all the
possibilities. Like me, you might be surprised.
Medical costs are the leading cause of bankruptcy for
Americans—especially the elderly. That is a frightening prospect. And being independent
is pretty important to most of us. Without rich kids, an inheritance, lottery
millions, or criminal gains I’ll have to plan a little more carefully—maybe even
cut down on my extravagant lifestyle. But we’ll make do. Once I got all the
information I was relieved to find that my costs would be in the thousands and
not the tens of thousands—a lot, but not a life changing amount. My wife has
decided to keep me. I’m sleeping better these days.
axman
