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How to pay for meds??

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Prostate Cancer
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Posted 9/18/2012 11:27 PM (GMT -5)
I am new here. My dad was diagnosed with PC in 1994 (he was 64) and had a prostatectomy (12/94) and was cancer free for 17 years. Last fall his PSA was 47 and he began hormone therapy (8/11) which worked for a year. I took him to MD Anderson last week - bone scan was negative, a blessing, but cancer was in several lymph nodes and his oncologist prescribed Zytiga. He is on Medicare and has additional health insurance but he is a vet and his prescription meds are through the VA. I am told they only cover generic medications unless (and only in some cases) a VA doctor prescribes them.

The drug is $9000/month!!! What regular person has that kind of money? We applied for the J&J patient assistance program but will have to wait...meantime, we wanted to keep my dad's hopes alive so my sisters and I charged the first month of his medicine ($9078.55 to be exact). I don't even make that in a month!

Does anyone have any experience with this drug? Is it effective? And how in the world do you pay for it? A friend said with Medicare Part D it's still about $5000/month. That is still WAY out of our price range. But how does a drug company come to market with a drug that is out of reach for the common person?? I am baffled. Our battle should be with the cancer - not with how to pay for the drugs to fight the cancer.

Any help is greatly appreciated. My dad will be 82 next month and I want to help him - he is my role model and hero. He is sharp, witty and full of energy and this &*^% disease is trying to take him away from us.

Thank you so much for any help/insight you can provide.

TxRose
Posted 9/19/2012 1:11 AM (GMT -5)
Have the MD Anderson Dr make up the prescription & take it to your dad's VA doctor. You go with your dad! Any problems call the VA patient advocate. Just my thoughts.
Posted 9/19/2012 3:58 AM (GMT -5)
TxRose

It's my understanding that MD Anderson and the VA hospital have a working relationship.  They are like across the street from each other.

You may also want to check out this website:  http://www.needymeds.org/drug_list.taf?_function=name&name=Zytiga

That site has a good collection of drug assistance forms.

Posted 9/19/2012 7:53 AM (GMT -5)
Ketoconazole could be tried and can be as low as $100-200/mo. from Canada Pharma's or probably 3x times that in the States. It also targets enzyme CYP17 as does Zytiga, but let's keep that quiet. He might also be a candidate for estrogenic type drugs and they can be low priced and work on hrpca, but you need the right kind of doc. Those fall into various ways of useage, pills, gels, transdermal patches. Anyway you seek other oncology docs and see what options they might offer, it varies but usually the expensive stuff is endorsed first and foremost.

Post Edited (zufus) : 9/19/2012 6:59:40 AM (GMT-6)

Posted 9/19/2012 8:11 AM (GMT -5)
If he is receiving VA care than he might have an oncologist and urologist from the VA. It might depend on "service connection" at the VA and his percentage if compensated.
Also does he have Medicare Part D drug insurance?
Good luck.
Posted 9/19/2012 9:50 AM (GMT -5)
TxRose,

Did you take the prescription to the VA or a military pharmacy?

You said "I am told they only cover generic medications unless (and only in some cases) a VA doctor prescribes them", which makes me ask if you tried. I have folks in my family who are surviving family of veterans, and at least on Tricare, the limitation has nothing to do with generic status or prescribing physician, but with what the military formulary allows. If the drug is on the list, they provide it. If not, you are on your own. And that 'on your own' situation happens, but I would be sure that they actually refuse for a valid reason, so that you have indication on how to get it fixed.

I would ask for clarification from the VA.

And, by the way, Welcome to HW. I hate to see that your dad has to get back into patient mode. We all dread the day that PSA starts back up.

Posted 9/19/2012 10:04 AM (GMT -5)
Another thing that caught my attention is the fact that this is a Chemotherapy drug. When I worked in Pharmacy Management for a major insurance company in their Medicare and Medicaid division we automatically approved all Chemo drugs whether on forumulary or not.

All the physician had to do was say the "the diagnosis is Prostate Cancer" and it would be approved on the spot.
Posted 9/19/2012 10:51 PM (GMT -5)
Thank you so much for your replies. My dad does not have the Medicare Part D prescription coverage - he gets his medications through the VA. He does not have a VA doc so, no, we have not tried to get Zytiga through them as we have no one to prescribe it. They told us to possibly have the VA cover it he would have to get a doc in the VA, go through all the tests again, and that the VA doc would have to determine that he needed this particular medication. Then, MAYBE, they would possibly prescribe it. That is a lot of maybes and ifs when I know his oncologist at MD Anderson said this is what he needs. Now.

It's not a chemotherapy drug. It inhibits the growth of testosterone. He was told that the hormone therapy he was on (Trelstar) only affected 90% of testosterone. It worked for a year and quit. This drug is supposed to stop all testosterone growth. Maybe, if this is the right treatment, we have to go back to square one and get a VA doc and start all over on the slim chance that they will cover it.

I know everyone's journey is different and if you are reading this then you or someone you love has been affected by this horrible disease. I appreciate your time and thoughts. God bless!
Posted 9/20/2012 10:28 AM (GMT -5)
TXrose ... I'm in a similar situation. PM me and i'll tell you my game plan. Ray
Posted 9/20/2012 11:38 AM (GMT -5)
He's 82.

Don't know the extent of it but if it's not that bad, he may not feel the effects of the cancer ever. My grandfather got PCa in his early 80s and died on his 90s of unrelated causes. He never treated the PCa. But it depends on its severity I suppose.

As for medical coverage, you touch a sore spot. I pay over $1200 a month for what is considered very good coverage. It's a plan only the Partners at my firm get. My wife went to a dermatologist last week over some minor skin issues that need taking care of according to the dermatologist but we were informed that our insurance would not cover the required medicine. It's an absolute joke.
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