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Thread: What's been your Experiance with Meds and paying for them?

  1. #1
    Senior User
    Join Date
    Mar 2017
    Posts
    100

    What's been your Experiance with Meds and paying for them?

    I check on the Forum: Financial issues and that forum has little active post. I know its the gorila in the room subject! I just changed over to a MO locally and he has put me on Xtandi and continue trelstar as it was keeping Tostostorone around 7. I was first told the Xtandi could only be gotten from a specialty pharmacy. After talking to him about cost he assured me he hasn't bankrupt anyone paying for meds! He directed me to the his groups specialty pharmacy told me that there were programs that would have me paying little or nothing for meds . Otherwise only millionaires could afford these meds.! When I talked with them the out of pocker with my insurance was $3400 a month? I have good insurance have never paid too much for anything! I ask about financial programs, he said he would look... said oh wait you have PCa all those are gone in beginning of year! I could try for a hardship from supplier. I needed to send last years tax forms to them and his experiance is that you need to make less that 100k for two people? I told him I worked full time last year and we made more than 100k he said he didn't think it was going to work has never seen anyone over 100k get free drugs! I'm like really 100k and the meds are 40k alone? I called my insurance to ask if they had a prefered specialty pharmacy to get the meds this way it goes to catastrophic. There answer was yes Walgreens, LOL Walgreens, they set me up with them to get the Xtandi. My insurance said I have to get the meds from them or they won't pay at network rates. I have told everyone in every office dept. Its taken 11 days to get the doctor to give up the script so I can order the meds. I've talked with the doctors pharmcy everyday and they just don't like to loose money on loosing the script! This whole network deal with doctors having there own surgery centers own pharmcy own rehabs and now I see own imedicare centers next to there office? If you call for an appt. they say 3 weeks or you can go next door at our imedicare center!
    I think Its been sent to my prefered pharmcy as of 10am still working the Trelstar issue?
    steve d
    Diagnosis 56: DOB 2/59 PSA 01/14 (2.0) 6/15/15 (2.4)
    Biopsy 6/23/15 5 positive very aggressive Gleason Score 8
    Bone Pet Scan & Biopsy of rib Neg
    Radical da Vinci 10/15/15
    Pathology 54g 5x4.2x2.8cm gleason's grade 4+3=7 Tumor location quadrants Bilateral
    Extent of local invasion: Extra-capsular extensions present,Semi vesicles no invasion
    Vascular invasion none, Perineural invasion identified ,Multicentricity : multifocal
    Margins involvement/Not present on inked margins lymph nodes : five negative Pathologic stage pT3a,N0
    PSA 10/6/16 .1 1yr PSA 02/02/17 .4 PSA 02/15/17 .5
    Pet Bone Scan 2/18/17 Neg
    PSA 03/08/17 .6
    03/17/17 Axumin trial 17.4mm recurrence rt. semi vascular bed
    03/29/17 Casodex + Triptorelin Pamoate Injections 2yrs Casodex 6/18
    04/03/17 SRT (42) completed 6/3/17
    08/31/2017 PSA < .1 Last 6 uPSA <.006 uPSA 2/19 <.030 2nd BCR 5/17/19 <.235 5/24/19 <.258
    06/10/2019 Pet w/Axumin inconclusive. Xtandi started say on Trelstar waiting xgeva in Aug.

  2. #2
    Senior User
    Join Date
    Jan 2019
    Posts
    396
    XTANDI and Trelstar are not available in a generic.

    You should ask your MO about generic alternatives and eliminate those as options first by trying them.

    You should ask your insurance company if your cost for drugs applies to your maximum annual out of pocket. My insurance has a $1500 maximum out of pocket for prescription drugs. My wife’s insurance covers 100% of drug costs after she hits her annual out of pocket.

    Unfortunately your gripe is with whoever selected your insurance coverage and opted to save $ over providing good prescription coverage.

    You might also need to find a new MO.
    Last edited by Duck2; 06-25-2019 at 06:18 PM.

  3. #3
    Senior User
    Join Date
    Mar 2017
    Posts
    100
    Quote Originally Posted by Duck2 View Post
    XTANDI is not available in a generic. You should ask you insurance company if your cost for drugs applies to to you maximum annual out of pocket. My insurance has a $1500 maximum out of pocket for prescription drugs.
    I have already done all that as posted above and have setteled the issue with getting the Xtandi at Walgreens. They are in the mail. The post was about these doctor networks that suck you in and tell you you can't get these drugs any wheres but here, and then are offened by you getting them else wheres. They have gamed the system to keep you within there network! This all about the benjamins...
    Diagnosis 56: DOB 2/59 PSA 01/14 (2.0) 6/15/15 (2.4)
    Biopsy 6/23/15 5 positive very aggressive Gleason Score 8
    Bone Pet Scan & Biopsy of rib Neg
    Radical da Vinci 10/15/15
    Pathology 54g 5x4.2x2.8cm gleason's grade 4+3=7 Tumor location quadrants Bilateral
    Extent of local invasion: Extra-capsular extensions present,Semi vesicles no invasion
    Vascular invasion none, Perineural invasion identified ,Multicentricity : multifocal
    Margins involvement/Not present on inked margins lymph nodes : five negative Pathologic stage pT3a,N0
    PSA 10/6/16 .1 1yr PSA 02/02/17 .4 PSA 02/15/17 .5
    Pet Bone Scan 2/18/17 Neg
    PSA 03/08/17 .6
    03/17/17 Axumin trial 17.4mm recurrence rt. semi vascular bed
    03/29/17 Casodex + Triptorelin Pamoate Injections 2yrs Casodex 6/18
    04/03/17 SRT (42) completed 6/3/17
    08/31/2017 PSA < .1 Last 6 uPSA <.006 uPSA 2/19 <.030 2nd BCR 5/17/19 <.235 5/24/19 <.258
    06/10/2019 Pet w/Axumin inconclusive. Xtandi started say on Trelstar waiting xgeva in Aug.

  4. #4
    Senior User
    Join Date
    Jun 2016
    Posts
    183
    You may want to check prices of meds available from Canadian pharmacies. Even without accepting US insurance, their drugs can be much less costly compared to buying in the US with insurance coverage. Canadian pharmacies list their prices for all drugs on line, so very helpful doing drug shopping. It is worth a little time on line to check prices.

  5. #5
    Senior User
    Join Date
    Jan 2019
    Posts
    396
    Quote Originally Posted by steve135 View Post
    I have already done all that as posted above and have setteled the issue with getting the Xtandi at Walgreens. They are in the mail. The post was about these doctor networks that suck you in and tell you you can't get these drugs any wheres but here, and then are offened by you getting them else wheres. They have gamed the system to keep you within there network! This all about the benjamins...
    My drug plan (managed by Express Scripts) has been accepted any where I have been and I have not had issues.

    It comes down to the $$$ the people providing your insurance plan opted to pay.
    Last edited by Duck2; 06-26-2019 at 03:58 AM.
    DOB 5/1957

    PSA - 11/2010=1.9, 6/12=2.3, 12/13=2.19, 12/14=2.64, 3/17=5.29, 3/17=3.91, 6/17=3.47, 12/17=4.50, 12/17=3.80, free PSA low risk (local (Uro, “My opinion you don’t have cancer), 8/18=5.13, 10/18=5.1, 10/19 ISO PSA 56% risk cancer. All DREs negative.

    DX 12/18, GS 8, 4+4 6/12 cores, LL Apex 100%, LM Apex 60%, LL Mid 50%, LMM 40%, LL Base 5%, LM <5%, Right side negative, (Uro opinion “This has been going on for a year”.... ah, more like 2 years ). Bone scan/CT negative

    2/25/19 R-LESS (Robotic Laparoendoscopic Single Site Surgery) outpatient Cleveland Clinic,

    3/6/19. Pathology - Grade Group 4 with Intraductal Carinoma
    T3aNO, GS8, 21 mm unifocal tumor 10%. -7 Nodes, - SV, - Margins, - PNI,
    - bladder neck neg., +LVI, + EPE non focal apex/mid lateral 1mm max extension, Cribriform pattern present. Decipher .86 High Risk. 38% risk 5 year metastasis.

    PSA 3/27/19 .03. (29 days)
    4/25/19 <.03. (58 days)
    5/25/19 <.02. (88 days)

    ADT started 6/3/2019

  6. #6
    Senior User
    Join Date
    Mar 2017
    Posts
    100
    Duck2 as you mentioned above I am leaving my MO locally as he is part of a group. RCCA (Regional Cancer Care Associates) is a large cancer group here on the east coast. My doctor is covered in network but it seems noting else in the group is. Its taken too long for them to get thier s together. And when they did they use there own Pharmacy which is not in my network and 5 times the cost! My drug plan goes towards out of pocket but only in network and that's where the issues are with this group. I'm using Penn Medicine as my primary MO!
    steve
    Diagnosis 56: DOB 2/59 PSA 01/14 (2.0) 6/15/15 (2.4)
    Biopsy 6/23/15 5 positive very aggressive Gleason Score 8
    Bone Pet Scan & Biopsy of rib Neg
    Radical da Vinci 10/15/15
    Pathology 54g 5x4.2x2.8cm gleason's grade 4+3=7 Tumor location quadrants Bilateral
    Extent of local invasion: Extra-capsular extensions present,Semi vesicles no invasion
    Vascular invasion none, Perineural invasion identified ,Multicentricity : multifocal
    Margins involvement/Not present on inked margins lymph nodes : five negative Pathologic stage pT3a,N0
    PSA 10/6/16 .1 1yr PSA 02/02/17 .4 PSA 02/15/17 .5
    Pet Bone Scan 2/18/17 Neg
    PSA 03/08/17 .6
    03/17/17 Axumin trial 17.4mm recurrence rt. semi vascular bed
    03/29/17 Casodex + Triptorelin Pamoate Injections 2yrs Casodex 6/18
    04/03/17 SRT (42) completed 6/3/17
    08/31/2017 PSA < .1 Last 6 uPSA <.006 uPSA 2/19 <.030 2nd BCR 5/17/19 <.235 5/24/19 <.258
    06/10/2019 Pet w/Axumin inconclusive. Xtandi started say on Trelstar waiting xgeva in Aug.

  7. #7
    Senior User
    Join Date
    Nov 2018
    Posts
    220
    My doctor proscribed generic Cialis, can't think of the name, and it was like $580 for 10 pills 20g. I have Blue Cross Blue Shield and they wouldn't pay any. Walgreens said they could find an online discount prescription card of some kind and get it down to $280. Seems awful high. Only a little over 4 months out from surgery will probably just wait.
    DOB 1955
    63 at dx
    3/2018 PSA 4.05 DRE normal refer to URO small town
    10/2018 PSA 6.28 DRE normal
    Bx 11/2018 12 cores 3 positive one 5% left mid two 50% left base
    GS 3+4=7 T1c
    Appt Mayo Clinic Phoenix Az 1/4/2019
    Dr. Paul Andrews recommend
    MRI 2/27/2019 Mayo AZ
    RALP 2/28/2019 Mayo AZ Dr. Paul Andrews
    Path: GS 3+4=7, Tertiary Gleason Pattern none, Grade Group 2
    Tumor presents moderate to extensive volume mainly on the
    posterior portion of prostate. Largest tumor nodule measures
    8 mm.
    Prostate: 21g 3.5 x 3 x 3 cm
    EPE: Absent
    Bladder Neck Invasion: Absent
    Seminal Vesicle Invasion: Positive (left seminal vesicle)
    Margins: Positive left lateral base and central base margins 2mm focus each
    Lymph Nodes involved: 0
    Lymph Nodes examined: 16
    Nerves spared right side only
    Path Staging (AJCC 8th Edition)
    Primary Tumor pT3b
    Regional lymph nodes: pNO
    Distant Metastasis: Mx
    Continence 99% 9 weeks
    ED Present
    Post Op PSA 4/17/2019 <.1
    PSA 5/2/2019 <.007
    PSA 6/10/2019 <.1

  8. #8
    Quote Originally Posted by nmguy View Post
    My doctor proscribed generic Cialis, can't think of the name, and it was like $580 for 10 pills 20g. I have Blue Cross Blue Shield and they wouldn't pay any. Walgreens said they could find an online discount prescription card of some kind and get it down to $280. Seems awful high. Only a little over 4 months out from surgery will probably just wait.
    nmguy, try here for your Cialis. I get my sildenafil from them.

    Their prices vary a bit over time according to market factors, but today their price for tadalafil (generic Cialis) is $1.00 per 20 mg, and $0.63 per 5 mg. Prompt shipping has been included. They require a Rx faxed from you doc, of course. Or shop around online -- you may find even cheaper.(My BCBS of NC coverage doesn't cover ED meds either, but these prices are pretty much equivalent to what a co-pay would be.)

    Djin
    Last edited by DjinTonic; 07-10-2019 at 02:48 AM.

  9. #9
    Senior User
    Join Date
    Nov 2018
    Posts
    220
    Thanks Djin

 

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