Re: prescription plan problems

[Guest guest]

I am speaking only of my experience. I have Medicare and a supplemental

government employees health plan. Here is my story and how my shots are totally

paid for at least up to now:

My regular allergist tested me for xolair and when he filed for the insurance,

they called and told me my monthly co-pay would be $365 a month (which for some

in this group is not a lot, but it was to us as our retirement income is fixed.

He would not do the Medicare because the docs have to purchase the med then file

the claim with medicare. It doesn't pay for them to do it that way unless they

have several patients at a time that are on the xolair--a money thing. When I

asked about medicare, the nurse suggested that I call an allergy clinic where

the doc was already giving xolair to a good number of patients. His clinic is

also a part of an ongoing xolair research study, so they would accept both my

supplemental insurance and file for the medicare.

Now, as I understand it, Medicare pays for their part of the xolair under a

clause that is similar to cancer treatment therapy--chemotherapy. So between my

supplemental and the medicare, I pay nothing.

It turned out to be a very beneficial move for me. I still go to my regular

allergist every six months and he is the one who oversees my medications; I go

to a pulmonologist every six months. This clinic doc ordered a ct scan of my

lungs and upper abdomen and a microscopic nodule was spotted in the lower left

lobe of my left lung. I don't know when this would have been done or if it

would have been found until maybe too late. So God was watching over me. I now

have a ct scan every six months and the pulmonologist monitors these results and

any other lung problems I have. (So far, no growth or change at all in three ct

scans.)

I am doing well on xolair and I think we would have found a way to come up

with the money even if I couldn't have gotten medicare to help, but it would

have been very hard on us.

You may have to do some calling yourself to find out how to get some help.

Xolair is worth is for me.

Adah

JoyCarol and <jclutterbuster@...> wrote:

I am a steroid dependent asthmatic since 1977, my pulmonologist is

sending me to an allergist to see if I qualify for Zolair. I have done

a little research and found this drug costs $10,000 a year and my

current prescription plan does not cover it. Does anyone know of any

medicare rx plans that will cover it?

---------------------------------

Boardwalk for $500? In 2007? Ha!

Play Monopoly Here and Now (it's updated for today's economy) at Games.

[Guest guest]

this is a very helpful explanation of how things work to those on Medicare.

Adah Voigt <asthmatic50@...> wrote: I am speaking only of my

experience. I have Medicare and a supplemental government employees health plan.

Here is my story and how my shots are totally paid for at least up to now:

My regular allergist tested me for xolair and when he filed for the insurance,

they called and told me my monthly co-pay would be $365 a month (which for some

in this group is not a lot, but it was to us as our retirement income is fixed.

He would not do the Medicare because the docs have to purchase the med then file

the claim with medicare. It doesn't pay for them to do it that way unless they

have several patients at a time that are on the xolair--a money thing. When I

asked about medicare, the nurse suggested that I call an allergy clinic where

the doc was already giving xolair to a good number of patients. His clinic is

also a part of an ongoing xolair research study, so they would accept both my

supplemental insurance and file for the medicare.

Now, as I understand it, Medicare pays for their part of the xolair under a

clause that is similar to cancer treatment therapy--chemotherapy. So between my

supplemental and the medicare, I pay nothing.

It turned out to be a very beneficial move for me. I still go to my regular

allergist every six months and he is the one who oversees my medications; I go

to a pulmonologist every six months. This clinic doc ordered a ct scan of my

lungs and upper abdomen and a microscopic nodule was spotted in the lower left

lobe of my left lung. I don't know when this would have been done or if it would

have been found until maybe too late. So God was watching over me. I now have a

ct scan every six months and the pulmonologist monitors these results and any

other lung problems I have. (So far, no growth or change at all in three ct

scans.)

I am doing well on xolair and I think we would have found a way to come up with

the money even if I couldn't have gotten medicare to help, but it would have

been very hard on us.

You may have to do some calling yourself to find out how to get some help.

Xolair is worth is for me.

Adah

JoyCarol and <jclutterbuster@...> wrote:

I am a steroid dependent asthmatic since 1977, my pulmonologist is

sending me to an allergist to see if I qualify for Zolair. I have done

a little research and found this drug costs $10,000 a year and my

current prescription plan does not cover it. Does anyone know of any

medicare rx plans that will cover it?

---------------------------------

Boardwalk for $500? In 2007? Ha!

Play Monopoly Here and Now (it's updated for today's economy) at Games.

[Guest guest]

My shots are under the cancer thing too. I didn't know

this until recently. I was looking at my insurance

forms and I saw Chemo treatments listed on there. I

was a bit shocked at first until I realized what it

was.

--- Adah Voigt <asthmatic50@...> wrote:

> I am speaking only of my experience. I have

> Medicare and a supplemental government employees

> health plan. Here is my story and how my shots are

> totally paid for at least up to now:

>

> My regular allergist tested me for xolair and when

> he filed for the insurance, they called and told me

> my monthly co-pay would be $365 a month (which for

> some in this group is not a lot, but it was to us as

> our retirement income is fixed. He would not do the

> Medicare because the docs have to purchase the med

> then file the claim with medicare. It doesn't pay

> for them to do it that way unless they have several

> patients at a time that are on the xolair--a money

> thing. When I asked about medicare, the nurse

> suggested that I call an allergy clinic where the

> doc was already giving xolair to a good number of

> patients. His clinic is also a part of an ongoing

> xolair research study, so they would accept both my

> supplemental insurance and file for the medicare.

>

> Now, as I understand it, Medicare pays for their

> part of the xolair under a clause that is similar to

> cancer treatment therapy--chemotherapy. So between

> my supplemental and the medicare, I pay nothing.

>

> It turned out to be a very beneficial move for me.

> I still go to my regular allergist every six months

> and he is the one who oversees my medications; I go

> to a pulmonologist every six months. This clinic

> doc ordered a ct scan of my lungs and upper abdomen

> and a microscopic nodule was spotted in the lower

> left lobe of my left lung. I don't know when this

> would have been done or if it would have been found

> until maybe too late. So God was watching over me.

> I now have a ct scan every six months and the

> pulmonologist monitors these results and any other

> lung problems I have. (So far, no growth or change

> at all in three ct scans.)

>

> I am doing well on xolair and I think we would

> have found a way to come up with the money even if I

> couldn't have gotten medicare to help, but it would

> have been very hard on us.

>

> You may have to do some calling yourself to find

> out how to get some help.

>

> Xolair is worth is for me.

>

> Adah

>

> JoyCarol and <jclutterbuster@...> wrote:

> I am a steroid dependent asthmatic since

> 1977, my pulmonologist is

> sending me to an allergist to see if I qualify for

> Zolair. I have done

> a little research and found this drug costs $10,000

> a year and my

> current prescription plan does not cover it. Does

> anyone know of any

> medicare rx plans that will cover it?

>

>

>

>

>

>

> ---------------------------------

> Boardwalk for $500? In 2007? Ha!

> Play Monopoly Here and Now (it's updated for today's

> economy) at Games.

>

> [Non-text portions of this message have been

> removed]

>

>

________________________________________________________________________________\

____Be a better Globetrotter. Get better travel answers from someone who knows.

Answers - Check it out.

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[Guest guest]

I also have Medicare. Xolair is not covered by Medicare prescription

plans because it is covered for any qualifying patient under Medicare

Part B with a 20% copay. Your doctor's office will do the footwork with

Medicare to get you approved for Xolair if you are carrying Part B

coverage. I had absolutely no hassles getting approved or continuing

with treatment - it's gone very smoothly. Hope it's the same for you if

you turn out to qualify medically for Xolair treatment.

Fran

>

> I am a steroid dependent asthmatic since 1977, my pulmonologist is

> sending me to an allergist to see if I qualify for Zolair. I have done

> a little research and found this drug costs $10,000 a year and my

> current prescription plan does not cover it. Does anyone know of any

> medicare rx plans that will cover it?

>

[Guest guest]

Joy - my pulmo dude has some sort of setup by which my shots are covered by

Medicare and my supplementary carrier, BCBS. It requires that I have the

shots administered by the hospital. I don't know the details, but perhaps

your allergist can find out how to set it up from the Xolair people.

Terry

----- Original Message -----

From: JoyCarol and

Sent: Thursday, May 17, 2007 5:03 PM

Subject: [ ] prescription plan problems

I am a steroid dependent asthmatic since 1977, my pulmonologist is

sending me to an allergist to see if I qualify for Zolair. I have done

a little research and found this drug costs $10,000 a year and my

current prescription plan does not cover it. Does anyone know of any

medicare rx plans that will cover it?

[Guest guest]

Fran - perhaps you know the answer to this. I get Medicare explanation of

benefit forms regularly covering all my medical expenses they cover EXCEPT

what they pay for the xolair shots. However, I can go to the website and

find the payments listed to a hospital I never heard of. The portion BCBS

covers (about $306 per series of shots) shows up on the eob forms they send

me. Go figure.

Terry

----- Original Message -----

From: tiredofsteroids

Sent: Thursday, May 17, 2007 9:22 PM

Subject: [ ] Re: prescription plan problems

I also have Medicare. Xolair is not covered by Medicare prescription

plans because it is covered for any qualifying patient under Medicare

Part B with a 20% copay. Your doctor's office will do the footwork with

Medicare to get you approved for Xolair if you are carrying Part B

coverage. I had absolutely no hassles getting approved or continuing

with treatment - it's gone very smoothly. Hope it's the same for you if

you turn out to qualify medically for Xolair treatment.

Fran

>

> I am a steroid dependent asthmatic since 1977, my pulmonologist is

> sending me to an allergist to see if I qualify for Zolair. I have done

> a little research and found this drug costs $10,000 a year and my

> current prescription plan does not cover it. Does anyone know of any

> medicare rx plans that will cover it?

>

[Guest guest]

You might consider trying to get the Xolair covered under your medical

plan rather than the prescription plan as I was forced to do because of

the expense. I found that the copayment for prescriptions under the

prescription plan paid only 35% of the cost and I was responsible for

65% of the cost of Xoliar. Under the medical plan I only have to pay

20% of the cost and the insurance picks up the rest. Plus, the total

out-of-pocket expense is only $1000.00 in my case. This means once the

out-of-pocket expense is reached the shots are paid in full. I will

reach the $1000.00 limit this month with only having to pay the

copayments for 5 months. This is better than paying $10,000.00 a year

in your case.

Check into this and let me know what you find out.

Steve Zimmerman

Have a Good Day

785-296-6947

-----Original Message-----

From: [mailto: ]

On Behalf Of JoyCarol and

Sent: Thursday, May 17, 2007 4:03 PM

Subject: [ ] prescription plan problems

I am a steroid dependent asthmatic since 1977, my pulmonologist is

sending me to an allergist to see if I qualify for Zolair. I have done a

little research and found this drug costs $10,000 a year and my current

prescription plan does not cover it. Does anyone know of any medicare rx

plans that will cover it?

[Guest guest]

Sorry, I don't know the answer to that question. You might want to

call Medicare and ask them.

Fran

> >

> > I am a steroid dependent asthmatic since 1977, my pulmonologist

is

> > sending me to an allergist to see if I qualify for Zolair. I

have done

> > a little research and found this drug costs $10,000 a year and

my

> > current prescription plan does not cover it. Does anyone know

of any

> > medicare rx plans that will cover it?

> >

>

>

>

>

>

>

>

[Guest guest]

aarp covers it but not fully

Joy Carol and <jclutterbuster@...> wrote: I am a steroid

dependent asthmatic since 1977, my pulmonologist is

sending me to an allergist to see if I qualify for Zolair. I have done

a little research and found this drug costs $10,000 a year and my

current prescription plan does not cover it. Does anyone know of any

medicare rx plans that will cover it?

---------------------------------

Get your own web address.

Have a HUGE year through Small Business.

[Guest guest]

I am a

steroid dependent asthmatic since 1977, my pulmonologist is

> sending me to an allergist to see if I qualify for Zolair. I have

done

> a little research and found this drug costs $10,000 a year and my

> current prescription plan does not cover it. Does anyone know of any

> medicare rx plans that will cover it?

Medicare itself covers Xolair - it is an injectable which is given in

the doctor's office. My medigap policy pays about $90 per month and

Medicare pays almost $500.

>

>

>

>

>

>

> ---------------------------------

> Get your own web address.

> Have a HUGE year through Small Business.

>

>