Although I am only 53, I am eligible for Medicare on July 1.
The reason?
I am legally disabled because of my metastatic cancer, and I have been collecting Social Security Disability for two years.
Silly me: I thought I had it all figured out. I have my Medicare Card, which gives me Part A (hospital coverage) and Part B (medical). Part A is free, and the $96.40 monthly premium for Part B will be deducted from my monthly Disability check.
I called WSHIP (Washington State Health Insurance Pool) to switch from the full coverage I have now to the WSHIP Basic Plan. That will be my supplementary policy, to cover what Medicare doesn't.
I talked to a very sane person named Teresa who said I didn't need to fill out the 12-page application form, just fax a letter requesting the change with a copy of my WSHIP card and my new Medicare card. So i will do that tomorrow.
But this is the question that no one has been able to answer, even Medicare:
Does Medicare Part B (the medical part) cover my Tykerb (lapatinib), which is an oral chemotherapy drug?
If it doesn't, I will be worse off on Medicare than I am now with WSHIP.
(Side note: I thought I might keep my present WSHIP coverage as a backup to Medicare, but the first person I spoke to at WSHIP today told me that I cannot use that WSHIP plan if I am eligible for Medicare, so no dice.)
So far today, I have spoken with Erin at Medicare, who read me the entire list of oral chemo drugs that Medicare Part B covers for the treatment of breast cancer, and Tykerb was not on the list, under either of its names. All she could say is, "It MAY be covered."
Obviously, MAY is not good enough when we are talking about a drug that costs more than $3,000 for a month's supply.
I also talked to Teresa, at WSHIP, as I mentioned, and Lisa, Vicky, and Crystal at the Medco specialty pharmacy, which supplies my Tykerb.
I figured if anyone would know whether Medicare Part B pays for this drug, the pharmacy would. But get this, the final answer--after very confused conversations with Lisa and Vicky (who said my "other insurance" would have to be billed before Medicare, which makes no sense--Medicare will be my primary coverage, as I told her)--was that THEY CANNOT ADVISE ME ON COVERAGE UNTIL AFTER JULY 1, WHEN MY INSURANCE GOES INTO EFFECT.
Do you hear the sound of me screaming? How am I supposed to choose my insurance coverage if I don't know what will be covered?
So, after spending an entire day working on this problem, I still don't have an answer.
Part D
I also spoke with Marla at SilverScript Plus, a Part D prescription drug plan. She told me the plan did cover Tykerb, but because it is a specialty drug, I would have to pay 33 percent of the $3,288 monthly cost. Then she quoted me a figure of $1,600 and change as being equal to 33 percent, which of course it is not, but by that point I didn't care. Either her math is wrong, or the percentage I would have to pay is wrong ...
I'll take this problem up again tomorrow.
In the meantime, I've e-mailed the head of WSHIP to see if she knows the answer, or can find out. Here's my e-mail:
Dear Karen--
I'm hoping that you can answer a question that, so far, no one has been able to answer.
I have been insured with WSHIP for several years, as I think you will recall, but as of July 1 I am eligible for Medicare because I will have been on Social Security Disability for two years on that date (I have metastatic cancer).
So I am faxing in the forms to switch my WSHIP coverage to the Basic plan, and of course I also need a Medicare Part D prescription drug plan. But this is the question:
Does Medicare Part B cover Tykerb (lapatinib), which is an oral chemotherapy drug?
I called Medicare and the person I spoke to read me the list of oral chemo drugs that are covered, and Tykerb was not on that list. All she could tell me is that it "may" be covered.
This is obviously not good enough, as this drug costs more than $3,000/month.
Can you help?
Jeanne Sather
The Assertive Cancer Patient
www.assertivepatient.com
See also: Letter to WSHIP
@ Jeanne Sather 2008.
