Wellness

[granddi]

A friend has just reported her lung cancer diagnosis. Her genetic testing revealed BRAF. She will be starting Mekinisk and Tafinlar. I just checked Good Rx and the cost shown: Mekinsik 30 tabs/$11,522.17 and Tafinlar 120 tabs/$9,566.37. I think the treatment is 10 months.

Which made me wonder if anyone would share experiences as to what insurance pays for these very specialized cancer drugs? 

[Love my grandkids]

@granddi  In 2017 I had surgery, chemo and radiation for colorectal cancer.

4 rounds of chemo, 3 weeks off, then 28 days of radiation, 3 weeks off and 4 more rounds of chemo. During radiation I had to take Xeloda, 2 horse pills after b/fast and 2 after dinner.

My Medicare and United Health Care supplemental covered all of it. I never had to outlay a penny during all of my treatment.

Xeloda is an oral form of chemo and I'm sure it's horribly expensive.

[tends2dogs]

If the drug is approved for what it is being prescribed for, insurance will most likely pay for it.  Now, that being said, it depends on your insurance, what your copay is, if you have RX insurance, etc.

Depending on the persons income, often the drug companies will offer a discount.  That is something, I believe, the doctor's office helps with......applying and filling out paperwork. 

If for any reason your friend has to be hospitalized overnight and would miss a dose, her major medical would pick up the cost of the med.

This was our experience, but that was over 10 years ago.  Perhaps things are different now.

I wish your friend all the best.

[RedTop]

My cousins spouse has been taking one shot a month for cancer of the spine that costs $20,000 and is covered by Medicare.   

[butterfly123]

@granddi 

Prayers and positive thoughts for your friend.

If your friend’s insurance or the pharmaceutical company doesn’t help with costs you may want to check Needy Meds dot com.

This website offers many services and is very helpful.

Not all benefits are income based. 

If I may of assistance, please notify me.

[granddi]

---

@RedTop wrote:

My cousins spouse has been taking one shot a month for cancer of the spine that costs $20,000 and is covered by Medicare.   

---

Since Medicare does not pay for drugs, he/she would have medicare Part D. Not all drug plans pay the same. But if the injection is given in the hospital, maybe Medicare A is paying?

[rrBerke]

@granddi  

prayers and positive thoughts for your friend.

[OnlyShopsOnline]

Our insurance has a cap of $5000 for out-of-pocket expenses.  Once we've reached that amount, everything else, including prescrptions, are paid for for the rest of the year.  Then, it starts all over again the following year.

It's been almost two years since my surgery for thyroid cancer and hyperparathyroidism.  With all of the testing, doctors' appointments, etc., and the surgery itself, it didn't take long to hit the $5,000 cap.  

Thank God, surgery was a cure for me, and I didn't need any further treatments, except for thyroid hormone replacement.  I have to take two name brand medications, and my insurance won't pay for either one of those.

[granddi]

---

@OnlyShopsOnline wrote:

Our insurance has a cap of $5000 for out-of-pocket expenses.  Once we've reached that amount, everything else, including prescrptions, are paid for for the rest of the year.  Then, it starts all over again the following year.

It's been almost two years since my surgery for thyroid cancer and hyperparathyroidism.  With all of the testing, doctors' appointments, etc., and the surgery itself, it didn't take long to hit the $5,000 cap.  

Thank God, surgery was a cure for me, and I didn't need any further treatments, except for thyroid hormone replacement.  I have to take two name brand medications, and my insurance won't pay for either one of those.

---

Thanks so much for sharing. 

So many think that if you have good insurance and if the doctor prescribled the medicine then no problem. It does not even have to be a cancer med to possibly create financial problem. 

My friend has good Medicare Part D but that is no guarantee of coverage of meds. When we buy these policies, we have no idea what meds we might need in the future.

Sounds like you are on your way to wellness..Great news