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Topic: Mets and on Medicare

Forum: Older Than 60 Years Old With Breast Cancer —

Meet other women who are similar in age and dealing with age-appropriate issues.

Posted on: Nov 2, 2019 11:47AM

Artista928 wrote:

Anyone here have mets and is on Medicare? I'm wondering if they cover chemo pills. I know they do IV. If not, how do you pay?

TIA

Dx'd at 50. Doing it all, all by myself. Stopped Letrozole after 5 weeks. Debilitating se's. Back on Tamox now. Dx 6/2/2015, IDC, Left, 6cm+, Stage IIIA, Grade 3, 1/4 nodes, ER+/PR+, HER2- (DUAL) Surgery 8/6/2015 Lymph node removal: Left, Sentinel; Mastectomy: Left; Prophylactic mastectomy: Right; Reconstruction (left): Tissue expander placement; Reconstruction (right): Tissue expander placement Chemotherapy 11/3/2015 AC + T (Taxotere) Radiation Therapy 5/2/2016 Whole-breast: Breast, Lymph nodes, Chest wall Hormonal Therapy 6/28/2016 Tamoxifen pills (Nolvadex, Apo-Tamox, Tamofen, Tamone) Surgery 12/9/2016 Reconstruction (left): Silicone implant; Reconstruction (right): Silicone implant Hormonal Therapy 2/14/2017 Femara (letrozole) Hormonal Therapy 3/26/2017 Tamoxifen pills (Nolvadex, Apo-Tamox, Tamofen, Tamone) Surgery 9/1/2017 Reconstruction (right): Fat grafting, Silicone implant
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Nov 3, 2019 10:46AM flashlight wrote:

Artista928, I don't have Mets, but if you are younger than 65 and have Medicare it will pay 80% of your cancer treatment. From another thread on this site about the ACA I learned that Medigap supplemental insurance is difficult to obtain so most go with a Medicare Advantage plan to cover the remaining 20%. If you don't have Medicare contact your MO and ask what they can do to help you.

Dx 11/15/2018, IDC, Left, 1cm, Stage IA, Grade 2, 0/1 nodes, ER+/PR-, HER2- Dx DCIS, Left, <1cm, Stage 0, Grade 1, 0/1 nodes Hormonal Therapy Tamoxifen pills (Nolvadex, Apo-Tamox, Tamofen, Tamone) Radiation Therapy Surgery Lumpectomy: Left
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Nov 3, 2019 04:36PM Artista928 wrote:

Thanks flashlight. I'm on social security disability for something else, not cancer. I have AARP plan F supplement too. I'm 55. I thought Medicare pays for IV meds but chemo pills falls under plan D which is for rxs and that's where I heard it doesn't. That's my confusion.

Dx'd at 50. Doing it all, all by myself. Stopped Letrozole after 5 weeks. Debilitating se's. Back on Tamox now. Dx 6/2/2015, IDC, Left, 6cm+, Stage IIIA, Grade 3, 1/4 nodes, ER+/PR+, HER2- (DUAL) Surgery 8/6/2015 Lymph node removal: Left, Sentinel; Mastectomy: Left; Prophylactic mastectomy: Right; Reconstruction (left): Tissue expander placement; Reconstruction (right): Tissue expander placement Chemotherapy 11/3/2015 AC + T (Taxotere) Radiation Therapy 5/2/2016 Whole-breast: Breast, Lymph nodes, Chest wall Hormonal Therapy 6/28/2016 Tamoxifen pills (Nolvadex, Apo-Tamox, Tamofen, Tamone) Surgery 12/9/2016 Reconstruction (left): Silicone implant; Reconstruction (right): Silicone implant Hormonal Therapy 2/14/2017 Femara (letrozole) Hormonal Therapy 3/26/2017 Tamoxifen pills (Nolvadex, Apo-Tamox, Tamofen, Tamone) Surgery 9/1/2017 Reconstruction (right): Fat grafting, Silicone implant
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Nov 4, 2019 04:40AM BevJen wrote:

Artista928,

I am on Medicare, over 65, and I also have Plan F plus a Plan D prescription plan through express scripts.I also have mets.

Medicare Part B will pay for things that you get at a hospital or doctor's office. This includes IV meds as well as things like faslodex/fulvestrant. That last drug can be given by shot (how I get it) or I believe that some centers now give it by pill (perhaps still in testing?) My understanding of the Medicare rules is that if it can be given in either pill or injection/IV form, then it's covered under Part B.

To find out for sure, you can check at medicare.gov, although I haven't had a lot of luck in calling in to the medicare help number. They don't seem to understand the question about meds. Perhaps your oncologist's staff can help you?

Also, I've found that at this time of year, the Part D people are extremely helpful because they want your business. You could try calling some of the larger Part D programs in your state and see what they say. I'll be they will help

Dx 11/2003, ILC, Left, Stage IIIC, ER+/PR+, HER2- Dx 6/2006, ILC, Stage IV, metastasized to other, ER+ Dx 5/2019, ILC, Stage IV, metastasized to liver, ER+/PR+, HER2- Surgery 7/5/2019 Targeted Therapy 8/1/2019 Ibrance (palbociclib) Radiation Therapy Surgery Lymph node removal: Left, Sentinel; Mastectomy: Left, Right; Reconstruction (left): Pedicled TRAM flap; Reconstruction (right): Pedicled TRAM flap Chemotherapy TAC Hormonal Therapy Faslodex (fulvestrant) Hormonal Therapy Tamoxifen pills (Nolvadex, Apo-Tamox, Tamofen, Tamone) Surgery Lymph node removal; Mastectomy; Reconstruction (left): Pedicled TRAM flap; Reconstruction (right): Pedicled TRAM flap Hormonal Therapy Femara (letrozole)
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Jul 18, 2020 10:33AM Hannahllrose wrote:

Can anyone tell me what "MO" stands for? Thank you.

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Jul 18, 2020 10:36AM BevJen wrote:

MO means Medical Oncologist (as opposed to a surgical oncologist, breast surgeon, etc.)

Dx 11/2003, ILC, Left, Stage IIIC, ER+/PR+, HER2- Dx 6/2006, ILC, Stage IV, metastasized to other, ER+ Dx 5/2019, ILC, Stage IV, metastasized to liver, ER+/PR+, HER2- Surgery 7/5/2019 Targeted Therapy 8/1/2019 Ibrance (palbociclib) Radiation Therapy Surgery Lymph node removal: Left, Sentinel; Mastectomy: Left, Right; Reconstruction (left): Pedicled TRAM flap; Reconstruction (right): Pedicled TRAM flap Chemotherapy TAC Hormonal Therapy Faslodex (fulvestrant) Hormonal Therapy Tamoxifen pills (Nolvadex, Apo-Tamox, Tamofen, Tamone) Surgery Lymph node removal; Mastectomy; Reconstruction (left): Pedicled TRAM flap; Reconstruction (right): Pedicled TRAM flap Hormonal Therapy Femara (letrozole)
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Jul 18, 2020 11:50AM MinusTwo wrote:

Hanna: Here's the link to the abbreviations. https://community.breastcancer.org/forum/131/topic...

Bev & Artists - I'd be interested in what you find out. I too have a traditional Medigap Supplement & a part D - Drug supplement. It's been my experience that pills come under the "part D" umbrella. But I do believe there are rules that anything has to be administered in a clinic or docs office.

2/15/11 BMX-DCIS 2SNB clear-TEs; 9/15/11-410gummies; 3/20/13 recurrance-5.5cm,mets to lymphs, Stage IIIB IDC ER/PRneg,HER2+; TCH/Perjeta/Neulasta x6; ALND 9/24/13 1/18 nodes 4.5cm; AC chemo 10/30/13 x3; herceptin again; Rads Feb2014
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Jul 18, 2020 02:11PM mac5 wrote:

Arista...I’m 70 and on Medicare A, B, and D for prescriptions. My Part D co-pay for Ibrance is over $2,000 per month.

The Medical Center Social Services helped me get on a Prescription Assistance Program for Pfizer, the manufacturer’s of Ibrance. If I can handle the SEs I’ll be on Letrozole and Ibrance ‘til...

Dx 7/20/2010, DCIS/IDC, Left, 2cm, Stage IIIB, Grade 2, 0/4 nodes, ER+/PR+, HER2- (IHC) Dx 9/5/2019, ILC/IDC, Both breasts, 6cm+, Stage IV, metastasized to lungs, Grade 1, 1/1 nodes, ER+/PR+, HER2- Chemotherapy 11/7/2019 CMF Radiation Therapy 6/5/2020 Whole-breast: Breast, Lymph nodes, Chest wall Surgery Lymph node removal: Sentinel; Mastectomy: Right; Reconstruction (left): Silicone implant, Tissue expander placement; Reconstruction (right): Silicone implant, Tissue expander placement Chemotherapy Abraxane (albumin-bound or nab-paclitaxel), Adriamycin (doxorubicin), Cytoxan (cyclophosphamide), Fluorouracil (5-fluorouracil, 5-FU, Adrucil) Surgery Lymph node removal: Sentinel; Mastectomy: Left, Right; Reconstruction (left): Tissue expander placement; Reconstruction (right): Tissue expander placement
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Jul 18, 2020 02:57PM BevJen wrote:

MinusTwo,

If a drug is available as both a pill and an infusion, then it's generally covered under Part B, not D. The pills don't have to be administered in a doctor's office or a clinic. The only thing that has to be administered in a doc's office, etc., is something akin to an infusion or a shot (e.g., faslodex) and that falls under Part B then.

I'm shocked by what mac5 writes about 2k a month. My copay for Ibrance is higher until I go into the donut hole then catastrophic, so the first payment of the year is very high. After that, I pay $594 a month. I haven't been able to qualify for any Pfizer or private foundation assistance bc I just retired.

However, you should look around and use the medicare part d tool at medicare.gov. During the open enrollment period each fall (I think Oct 1- to about Dec 1) you can switch your Part D program. I have express scripts, which seemed to work out the best for me, but in other states (I'm in Maryland) it may be different.

Dx 11/2003, ILC, Left, Stage IIIC, ER+/PR+, HER2- Dx 6/2006, ILC, Stage IV, metastasized to other, ER+ Dx 5/2019, ILC, Stage IV, metastasized to liver, ER+/PR+, HER2- Surgery 7/5/2019 Targeted Therapy 8/1/2019 Ibrance (palbociclib) Radiation Therapy Surgery Lymph node removal: Left, Sentinel; Mastectomy: Left, Right; Reconstruction (left): Pedicled TRAM flap; Reconstruction (right): Pedicled TRAM flap Chemotherapy TAC Hormonal Therapy Faslodex (fulvestrant) Hormonal Therapy Tamoxifen pills (Nolvadex, Apo-Tamox, Tamofen, Tamone) Surgery Lymph node removal; Mastectomy; Reconstruction (left): Pedicled TRAM flap; Reconstruction (right): Pedicled TRAM flap Hormonal Therapy Femara (letrozole)
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Jul 18, 2020 03:35PM mac5 wrote:

BevJen...my co-pay could be 3xtremely high because I have a low monthly cost Part D. The Plan may have Ibrance on a super high tier. Of course, when I purchased the Plan I had no idea I was going to be taking the drug. I’m not a big fan of Big Pharma, but without the Research where would we all be

Dx 7/20/2010, DCIS/IDC, Left, 2cm, Stage IIIB, Grade 2, 0/4 nodes, ER+/PR+, HER2- (IHC) Dx 9/5/2019, ILC/IDC, Both breasts, 6cm+, Stage IV, metastasized to lungs, Grade 1, 1/1 nodes, ER+/PR+, HER2- Chemotherapy 11/7/2019 CMF Radiation Therapy 6/5/2020 Whole-breast: Breast, Lymph nodes, Chest wall Surgery Lymph node removal: Sentinel; Mastectomy: Right; Reconstruction (left): Silicone implant, Tissue expander placement; Reconstruction (right): Silicone implant, Tissue expander placement Chemotherapy Abraxane (albumin-bound or nab-paclitaxel), Adriamycin (doxorubicin), Cytoxan (cyclophosphamide), Fluorouracil (5-fluorouracil, 5-FU, Adrucil) Surgery Lymph node removal: Sentinel; Mastectomy: Left, Right; Reconstruction (left): Tissue expander placement; Reconstruction (right): Tissue expander placement
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Jul 18, 2020 04:02PM candy-678 wrote:

Just reading along for information for the future. I do not have Medicare yet, yet. I am on Social Security Disability as of January. So in 1 1/2 years I will switch to Medicare. I am now on COBRA and getting my health insurance from my old employer. My co pay for Ibrance is $35.00 a month!!! So, wow, looks like I will go broke when I get on Medicare!!!! I was hoping Medicare, even with a supplement, would be better than COBRA health insurance. Sounds like I was wrong in my thinking. Sigh.....

Found mets on CT for unrelated issue. I only had 2 treatments with IV chemo for the Stage II, then found Stage 4 and switched to hormone therapy/targeted therapy. I consider myself de novo. Also using Xgeva injections for bone mets Dx 6/2017, ILC/IDC, Left, 3cm, Stage IIB, Grade 3, 0/1 nodes, ER+/PR+, HER2- Dx 9/2017, ILC/IDC, Stage IV, metastasized to bone/liver, 0/1 nodes, ER+/PR+, HER2- Targeted Therapy Ibrance (palbociclib) Hormonal Therapy Femara (letrozole), Zoladex (goserelin) Chemotherapy AC Surgery Lymph node removal: Sentinel; Mastectomy: Left
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Jul 18, 2020 04:32PM BevJen wrote:

Mac5- I pay very little for my Part D, but I check every fall during open season to see what each plan will do. You should keep that in mind. You are NOT Locked into your Part D program

Candy, I don't know much about this, but if you are willing to forego the choice of a physician and to get referrals, you can always go into a Medicare Advantage plan. In some states, those cover a whole lot more. I'd start trying to look into this now. A lot of people like them, especially when they end up covering the same docs as you already use. Or you can try to get a grant from one of the foundations supported by Big Pharma -- just look at info that Jaycee has posted a number of times on the Ibrance thread.

Dx 11/2003, ILC, Left, Stage IIIC, ER+/PR+, HER2- Dx 6/2006, ILC, Stage IV, metastasized to other, ER+ Dx 5/2019, ILC, Stage IV, metastasized to liver, ER+/PR+, HER2- Surgery 7/5/2019 Targeted Therapy 8/1/2019 Ibrance (palbociclib) Radiation Therapy Surgery Lymph node removal: Left, Sentinel; Mastectomy: Left, Right; Reconstruction (left): Pedicled TRAM flap; Reconstruction (right): Pedicled TRAM flap Chemotherapy TAC Hormonal Therapy Faslodex (fulvestrant) Hormonal Therapy Tamoxifen pills (Nolvadex, Apo-Tamox, Tamofen, Tamone) Surgery Lymph node removal; Mastectomy; Reconstruction (left): Pedicled TRAM flap; Reconstruction (right): Pedicled TRAM flap Hormonal Therapy Femara (letrozole)
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Jul 19, 2020 01:48AM AliceBastable wrote:

I have a Medicare Advantage plan. If you live in a smaller town, they're not so good because of lack of options. In large urban areas, they're great, I even got to keep my primary doctor (although I've switched to another one since because I like her better). I don't pay a Part D premium, and my regular prescriptions (blood pressure, cholesterol, low-level diabetes and a beta blocker) are all free. I don't know about more complicated and expensive drugs - perhaps Google Medicare Advantage Plans and look for information on pharmacy benefits.

Endometrial cancer 2010, basal cell multiples, breast cancer 2018, kidney cancer 2018. Cancer's a bitch, but I'm a bigger one with more practice. Dx 5/2018, ILC/IDC, Left, 2cm, Stage IA, Grade 2, 1/1 nodes, ER+/PR+, HER2- Surgery 7/11/2018 Lumpectomy: Left; Lymph node removal: Sentinel Surgery 8/8/2018 Radiation Therapy 10/29/2018 Whole-breast: Breast, Lymph nodes
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Jul 19, 2020 04:30AM Spookiesmom wrote:

DH and I both have cancer. Both stage IV. We have Medicare Advantage plans. Neither of us pay for them. Yes, we pay for Medicare, not the insurance. Which is covering all our expensive meds. The MOs office did the paperwork for my Ibrance, I don’t pay anything for it. All my other meds are $3.60 for 90 days.

As was said, you can change during open enrollment starting in October. Do your homework now, talk to various reps to see what would work best for you. Yes, it can be very confusing, start now.

Reoccurrence 3-19. Dx IDC, Stage IIIA, Grade 3

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