Part D Drug Plan - chemotherapy drugs not covered?

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LadyIJ
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Part D Drug Plan - chemotherapy drugs not covered?

Post by LadyIJ » Sun Oct 27, 2019 5:21 pm

I've been shopping around for my husband and mom, and I noticed that chemotherapy drugs are not covered on Part D. Luckily, neither one needs these (knock wood!) but what happens if one DOES need them?

jebmke
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Re: Part D Drug Plan - chemotherapy drugs not covered?

Post by jebmke » Sun Oct 27, 2019 5:28 pm

have you checked to see if it is covered under A or B, depending on how it is administered?
When you discover that you are riding a dead horse, the best strategy is to dismount.

ester
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Re: Part D Drug Plan - chemotherapy drugs not covered?

Post by ester » Sun Oct 27, 2019 5:29 pm

I believe chemo is covered under Medicare Part B

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Steelersfan
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Re: Part D Drug Plan - chemotherapy drugs not covered?

Post by Steelersfan » Sun Oct 27, 2019 5:51 pm

ester wrote:
Sun Oct 27, 2019 5:29 pm
I believe chemo is covered under Medicare Part B
Yup

https://www.medicare.gov/coverage/chemotherapy

InMyDreams
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Re: Part D Drug Plan - chemotherapy drugs not covered?

Post by InMyDreams » Sun Oct 27, 2019 10:21 pm

Steelersfan wrote:
Sun Oct 27, 2019 5:51 pm
ester wrote:
Sun Oct 27, 2019 5:29 pm
I believe chemo is covered under Medicare Part B
Yup

https://www.medicare.gov/coverage/chemotherapy
And the coverage outlined mentions hospitals, doctor's offices and clinics.

Lotsa new chemo drugs are taken at home and purchased at a pharmacy. Does anyone know how those are covered?

Mr. Rumples
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Re: Part D Drug Plan - chemotherapy drugs not covered?

Post by Mr. Rumples » Sun Oct 27, 2019 11:46 pm

Not exactly the same, but now that my sister-in-law is on Medicare, she has had to switch from self administered shots for her rheumatoid arthritis to going into a facility to have them administer it to have it covered.

Topic Author
LadyIJ
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Re: Part D Drug Plan - chemotherapy drugs not covered?

Post by LadyIJ » Mon Oct 28, 2019 12:16 pm

Interesting and comforting that it's most likely under Plan B - I never would have thought about it, but that we just changed plans and I noticed they state they are not covered. Thanks for the replies.

Topic Author
LadyIJ
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Re: Part D Drug Plan - chemotherapy drugs not covered?

Post by LadyIJ » Mon Oct 28, 2019 12:16 pm

Interesting and comforting that it's most likely under Plan B - I never would have thought about it, but that we just changed plans and I noticed they state they are not covered. Thanks for the replies.

desiderium
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Re: Part D Drug Plan - chemotherapy drugs not covered?

Post by desiderium » Tue Oct 29, 2019 9:25 am

LadyIJ wrote:
Mon Oct 28, 2019 12:16 pm
Interesting and comforting that it's most likely under Plan B - I never would have thought about it, but that we just changed plans and I noticed they state they are not covered. Thanks for the replies.
It's complicated, like everything in health care these days. Chemotherapy administered at a center is thoroughly covered by parts A and/or B, billed a little differently depending on whether they are administered in a facility considered hospital-based, or in a doctor's office. If you have parts A, B and a supplement, you are almost always good. Of course, some medicare advantage plans have PPO networks that may restrict or direct your referrals to preferred providers. With only a couple of exceptions, drugs for self-injection or oral use come from a pharmacy and are paid under part D. Generally these are covered if they are being prescribed for the FDA-approved use, but are subject to annual copays, the so-called donut-hole. Because of cost and special handling issues, most chemotherapy drugs do not come through the local pharmacy, rather from mail-order specialty pharmacies. In general, these items are precious and lucrative, so you get personalized attention from the staff and it works efficiently. The copay issues are tough for some people, so the drug industry funnels money through patient assistance foundations, and people often find help there, though income statements are typically required.

Cancer is most common in older people and is an enormously profitable industry these days. It is uncommon for Medicare patients not to have access to needed treatment.

Shallowpockets
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Re: Part D Drug Plan - chemotherapy drugs not covered?

Post by Shallowpockets » Tue Oct 29, 2019 9:37 am

LadyIJ wrote:
Sun Oct 27, 2019 5:21 pm
Luckily, neither one needs these (knock wood!) but ewhat happens if one DOES need them?
Why be worried under those circumstances? With that thought process you could search around for all kinds of things that, knock on wood, could happen.

Grasshopper
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Re: Part D Drug Plan - chemotherapy drugs not covered?

Post by Grasshopper » Tue Oct 29, 2019 9:45 am

Shallowpockets wrote:
Tue Oct 29, 2019 9:37 am
LadyIJ wrote:
Sun Oct 27, 2019 5:21 pm
Luckily, neither one needs these (knock wood!) but ewhat happens if one DOES need them?
Why be worried under those circumstances? With that thought process you could search around for all kinds of things that, knock on wood, could happen.
New on Medicare Ms G thought the same thing when researching "D" the plan had a note that no chemo drugs were covered. I showed her that she will be covered under A/B if delivered at a care center.

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