prescription/medication coverage after transplant???

[marlinfshr]

I'm still new to this whole mess but am trying to look ahead to the future. I have a positive outlook so I believe I will get a transplant and have my initial orientation/screening with the transplant team the beginning of August. I am currently on HD with a tentative appointment for a PD catheter in mid July.

I am trying to see what my best options will be for my medications post transplant as I understand they can be right pricey. Are there any prescription programs I can enroll in now or would it be to late now that I already have been diagnosed with ESRD?
Currently I have BCBS which has been covering everything in hospital or clinic after I reached my out of pocket. I don't have a prescription plan through them though so the meds I'm being prescribed now are all payed for out of my pocket.
I was just approved for SSDI which will kick in in November.
I understand that I should be able to qualify for medicare as well. Would that include prescription "plan D? My SW doesn't recommend applying for it until the end of the year though, because all my out of pocket from BCBS has been payed for the current year.
However, medicare would end 3 years post transplant?
I also don't qualify for any means tested programs such as medicaid and SSI.
That's why I'm trying to see if there are any prescription plans that I would qualify for now so I can be prepared for when I finally get the call.

[Sydnee]

Can't help with the transplant drug question.

You do qualify for Medicare. It would not cost anything for part A (hospital), There is B(doctor/clinic) which costs money, and part D (prescription) also costs money.  This is a very simplified way of looking at it. I don't know how long you have been doing dialysis or how much your out of pocket is for BCBS. You can apply for medicare at the start of dialysis. If you start home dialysis with-in three months Medicare will be in affect back when you started dialysis. If you stay with in-center dialysis Medicare will start at the beginning of your 4th month of dialysis.

Does your SW know you are paying for prescription drugs out of pocket? I can't believe the SW would have not worked that out for you. There are several options the SW should have caught that. Wish I knew more about prescription coverage for you.   

[marlinfshr]

Thanks. I don't remember mentioning anything to her as my meds aren't too much at the moment. My cardiologist switched me to plavix from effien so I can get the generics. I have a couple more as well and though 100/month total adds up, it's not the end of the world (yet!). But what I've been reading about post transplant costs, I want to start getting situated now. Perhaps I should bring up to my SW about medicare again and get the ball rolling. At least so I can get on the Part D.
I think her reasoning to wait was since I've already paid my out of pocket of 4000.00 to BCBS, she felt it would be cheaper for me to not start medicare until the new year when everything starts over. But if I could put off the plan B since BCBS has been covering that it might be a good move.
I had my heart attack the end of April and started dialysis May 1st so it's been 2 month's.

[cattlekid]

If you have Medicare and get a transplant, Part B will cover ONLY the drugs related to the transplant and ONLY for three years after the transplant.  This is why some centers will require you to come up with quite a bit of ready cash if you don't have another source of prescription insurance. 

Personally, all of my transplant related drugs are generic and I get my prescription drugs through my employer insurance.  It is about $100 total for a three month supply of everything.  But not all centers will be willing to do generics and not all people can tolerate the generics. 

It is my understanding that those of us who have Medicare due to ESRD and not age do not qualify to buy a Part D plan, but I may be wrong on this so you should check with your transplant center social worker.

[marlinfshr]

I need to check about the part D. Hopefully that is not the case. As of now, my current insurance will cover anything while in the hospital but once I'm released, I'm on my own. I plan on signing up for medicare though.

At the moment, I'm only 2 month's into dialysis and my transplant screening isn't until August. So in reality, it will be a while before any transplant actually happens. I just figure I'll use the time before hand to set myself up with some medication plan if at all possible with my now pre-existing condition.
Perhaps I could contact my current BCBS and see if there is another policy I could qualify for which includes that. Even with a higher deductible it might make sense. Of course, the question is will they let me now?

[Sydnee]

Ed  (my hubby) gets part D and he is 51, so I know that at least some can get it. He also gets the "extra help" with part D. which he qualified for even though he doesn't qualify for medicaid or SSI. He is still working full time.
I thought you should look at www.medicare.gov lots of good info plus you can try there online see if you qualify for extra help (you never know).

[Bill Peckham]

If you are qualified for SSDI then you will qualify for Medicare no matter your age or ESRD status and anyone who qualifies for Medicare qualifies for Part D (some people pay more if they didn't sign up when they first could - these rules are complicated, basically if you sign up for Medicare sign up for the whole package).

The one question is if you will continue to qualify for SSDI post transplant - if you are no longer disabled post transplant and are not old enough to qualify due to age and/or return to work, then you may lose access to SSDI and Medicare. However the other piece to consider is that in about 90 days insurance under the Affordable Care Act will become available, so if three years post transplant you lose SSDI/Medicare because you are feeling well then you'll be able to purchase insurance that will cover transplant meds, keeping in mind that Medicare and policies under the Affordable Care Act require copays of 20% +/-

[skg]

Personally, all of my transplant related drugs are generic and I get my prescription drugs through my employer insurance.  It is about $100 total for a three month supply of everything.  But not all centers will be willing to do generics and not all people can tolerate the generics. 

$100 doesn't sound so bad -- I guess perspective is everything. I just got a three month supply of insulin and test strips and dropped over $1000. Blech. That's the first time the bill has been over $1000 for one batch of meds, though.

cheers,
skg

[marlinfshr]

I just read in another post that someone was denied getting listed for a transplant because they don't have prescription coverage. In that case would it be a good idea for me to apply for medicare part A & B now? How long would it take to be approved for medicare? I have an appointment the 2nd of August for evaluation and I'd hate to be sent home right away because I currently have no prescription coverage but qualify for medicare which I understand covers the drugs---up to 3 years after.

Once again I'm wondering why my SW would have me wait to the beginning of the year to apply if that is the situation. I'm actually quite worried and a bit upset. I see her reasoning---I've already paid my out of pocket for the year on my insurance and I'd basically be paying the medicare premiums for nothing. But if I need that to get approved for a transplant and she suggested I'd wait----that makes me pretty P O'd!

[cattlekid]

Marlinfshr, I completely agree with you and did exactly the same thing.  I had a transplant evaluation scheduled for July of last year.  So I took my happy behind down to the Medicare office as soon as I had the evaluation appointment scheduled so even though I might not have been completely approved, I could at least show the transplant center that I had started the process, even though I knew that my employer insurance would pay 100% for everything if I was able to catch a transplant while I was still in the 30-month coordination period where the employer insurance would still be primary. 

I did end up paying the Medicare premiums for half of 2012 for nothing but I guess in the grand scheme of things it was worth it.  Now though, I am trying to decide if I should stop paying Medicare because I have my transplant, my meds are affordable, I'm young(ish), I have no other comorbidities and I have no reason to believe that I will be back on dialysis any time in the foreseeable future.  The $300ish dollars every quarter would definitely be better spent elsewhere at this time, like putting in savings.  As of this moment, I have paid Medicare $1200 in premiums since July of last year and gotten exactly $0 back in coverage.  Guess I will wait to see what this November's open enrollment brings at work and if they decimate our health coverage (unlikely), I will reevaluate - otherwise, I think Medicare and I are going to part ways.

[Sydnee]

If you start applying now you may have coverage by your appointment. Keep on top of getting that one important form they want. That is what took the longest for Ed. Not sure whether us ESRD people can apply on line but that would speed things up. I would try online if I were in your shoes. The first bill is a doozie it's 7 months.

[nursey66]

My Hubby takes Azathioprine & prednisone for anti-rejection, they only cost $30.00 & 4.00 for a month supply . He used to have cellcept, which was $900.00 a month !!!!  Part D will only pay for  $2970.00 worth of meds and then you are in the doughnut hole for the next $4750.00 of meds , so the higher priced suppression meds burn up the part D pretty quickly !!! He got all his meds through my work BCBS untill I retired a few months ago. I had a small stock pile of Cellcept from getting it for 10 years, so didn't have to use up the part D on that, but was wondering what we would do when it ran out, and then he was hospitalized for diarrhea ,and the DR blamed the Cellcept and changed him to the Azathioprine that costs our part D plan only $30.00 a month.

[jeannea]

I got my transplant last year. I had active CMV in the past so I got Valcyte. Got through that donut hole in one month's supply. Unfortunately none of us can really tell you what your meds will cost. It depends on what insurance you have.

Please don't use 10 year old Cellcept anyone. That's not safe.

[nursey66]

I only had about 6 months worth of Cellcept, and of coarse,always rotated using oldest up 1st. So none was 10 years old, my hubby was on it for 10 years.