$$561 a month for Xeloda on Medicare??? Help!!

[Awreed]

Xeloda costing me $561 a month on Medicare?? Anything I can do? I have Aetna supplemental but evidently Xeloda is not covered by my rx coverage but rather my medical coverage which I have to pay 20% up to my max out of pocket. Anyone have experience with this?

[Pita]

I don't use Xeloda but I did find this info on the Medicare site that might explain it. Best wishes...

https://www.medicare.gov/coverage/prescription-drugs-outpatient.html

[DH2Sleen]

Xeloda costing me $561 a month on Medicare?? Anything I can do? I have Aetna supplemental but evidently Xeloda is not covered by my rx coverage but rather my medical coverage which I have to pay 20% up to my max out of pocket. Anyone have experience with this?

When Sleen was considering Xeloda, the pharmacy called to inform us that our copay would be $800/round every 3 weeks. That would be about $14k/yr. They asked if our doctor required the brand name because they could send us generic for $10/round => $180/yr. The doctor had no problem with changing the prescription... (ended up never using the pills)

So, see about getting your doctor to prescribe generic.

[BrownBagger]

The generic drug is called Capcetibine.

With Xeloda, you may be able to get a "copay card" from the mfg., which means you only have to pay 15% of your bill. Not sure if this program is still in effect, but I used it for over a year and it was very helpful. Just google "Xeloda co-pay card."

[BeansMama]

I have never been on xeloda but I do know many drug manufacturers have assistance programs that help patients that cannot afford the medications. It might be something to look into if you cannot get the generic.

[mypinkheaven]

If you're low income you can apply for "Extra Help". Or Medicaid.

You can also shop for a better Drug Plan:

https://www.medicare.gov/find-a-plan/qu ... /home.aspx

You may have to call - I tried finding a Drug Plan, but it said my prescriptions weren't in the plans formulary. That's because, even though I entered only the prescriptions I'm taking now, all the drugs I had in the hospital were still included in cyberspace. I called, the very nice rep deleted those drugs and found me a plan.

I believe that if you enroll in a "5 Star" Plan, you don't have to wait for open enrollment.

[juliej]

I agree with DH2Sleen. Get your onc to prescribe the generic form of Xeloda. It went generic in 2013.

There is also a non-profit Patient Assistance Program that covers Xeloda. To qualify, you must have insurance and a valid prescription. You will also need to have been diagnosed with a disease that the program covers. In your case, that's not a problem! They get the manufacturer (Genentech) to donate the copayment amount. You can fill out an application online.

http://www.mygooddays.org/apply/

[Awreed]

Clarification-the $561 is for the generic!

[weisssoccermom]

FYI - those on Medicaid, Medicare and/or Tricare are NOT eligible to utilize programs like copay assistance. It has something to do with the govt run programs and the relationship with the drug companies. They all have that caveat written into the wording.

Last time I looked for someone, the Xeloda copay assistance program was gone from their site.

[betsydoglover]

Make sure your pharmacy is filing correctly. I've been told that XELODA is treated as chemo treatment and is not covered as a drug but rather as a Part B treatment. Check that out.

[Carolinabluetec]

I went through adjuvant therapy with generic Xeloda on Medicare. It was covered under Part B benefits. My Medigap is BCBS plan F with covers all co-pays and deductibles. So I had no out of pocket expenses.