The cost of cancer drugs has been skyrocketing.  Put that together w/Medicare D(isaster) and the result could very well be death in many instances.  

Take the case of Frances Blue, a retired teacher who is fighting cancer.  Prior to  her doctors changing her rx to Tacerva and Medicare D(isaster) taking effect, her medications were affordable.  Now, Ms. Blue can no longer afford the cost of her rx’s, although her monthly income is approximately $4000.00 as the price of Tacerva, a medication from Genentech, is about $3,000 a month.

To make matters worse, her Medicare D(isaster) plan requires  $3,600 annually in co-payments prior to Medicare D(isaster) kicking  in.  Also, her monthly income is too high to qualify for charitable programs that assist patients with co-payments.

Cancer is spreading through Ms. Blue’s lungs, as she is now getting no medication at all.

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Despite conversations w/doctors, patients, drug makers and charitable foundations, the end result is Medcare D(isaster) is life-threatening for approximately 10,000 people who were receiving free cancer medicines. (In addition to Tacerva, Gleevec and  Thalomid were formerly available in free programs for those who qualified.)  However, under Medicare D(isaster), the regulations require those who have enrolled in the program to pay $3600.00 in out of pocket costs per year.  

Oral cancer rx’s can run approximately $4000.00 per month!  Also, rx companies are sometimes forcing those who used to qualify for assistance into choosing a Medicare D(isater) plan.  But, some refuse to, so they can continue to receive qualify for some rx maker’s charity programs and continue to receive their rx’s.

Maye Navarre, a 79-year-old retiree, was receiving free Tarceva from Genentech, until she signed up for a Part D program through Blue Cross.  After checking with her pharmacy, she was told that Tarcerva would cost her $1,425, not $25.00 as she was told by an insurance agent.  She cancelled her Medicare D(isaster) coverage  to again participate in the charity program.  However, she was only given a one-month supply with the warning that she would no longer be eligible for the charity program until BCBS processed her cancellation of Medicare D(isaster).  That is a process that may not be completed, as some insurance carriers quit processing  “dis-enrollment” notices, as they could no longer tell which ones were valid.    

Unlike many drug makers, Genentech has not required Medicare patients in its free-drugs program to enroll in Part D. But once patients join Part D, Genentech bars them from participating in the company-run program, because it does not want to run afoul of Medicare’s complex rules that cover patients who are enrolled in Part D but are also getting free drugs from manufacturers.

Here is the rationalization:

government rules are forcing them to back away…companies say certain of their assistance programs could be interpreted as a kickback to win loyalty to their prescriptions.


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