The New Gold $tandard

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