Topic: Does Medicare cover routine chemo drugs like Xeloda and Gemcitibine

Hi,
We have been on this site for 19 months now but Joe has always had alternative treatments.  We didn't want the side effects of regular chemo when he was feeling so well.  The alternative treatments were not covered at all and were astronomical but if they were working i wasn't complaining.  However now we have decided to try conventional because of the cost and we think the IPT has done all it could.
Now I'm wondering does Medicare cover these chemo drugs?  Also I see
people referring to CA 125 as a tumor marker as well as CA 19-9  In the past, the CA 19-9 was covered but they wouldn't cover the CA125 becasue they said it was for ovarian cancer.  Anyone have any experience with that?  Joe will be starting this new treatment as soon as his bilirubin get low enough after severe jaudice caused by bile duct blockage.  Hopefully in the next few weeks.  do you have to ask the doctor each time they order something new if it is coverd by insurance or do they check that out to make sure they will get paid.  Any help would be appreciated.  Mary anne

Re: Does Medicare cover routine chemo drugs like Xeloda and Gemcitibine

I am pretty sure they are covered as when I went back to the US in the middle of the reoccurance scare, the doctor at UNC said that I could get on medicare and that it had good coverage and would have covered me for radiation, surgery and chemo if i had qualified to get on. She made it sound like everything I would need would be covered.

Kris

Cancer is a word, not a sentence.

36 year old patient with buckets of hope

3 (edited by JeffG Thu, 27 Mar 2008 10:38:28)

Re: Does Medicare cover routine chemo drugs like Xeloda and Gemcitibine

Mary Anne... tumor marker test are still a debate for alot of insurance companies.  Some will authorize some won't.  Some will request additional justification before okaying.  Personally, your scans CT, MRI, Bonescan are your best tools for evaluating progression or non-progression.  Tumor marker tests are really still considered still in research stage due to there is an issuse of false positive and negative results and it is different on different people.  Your weekly CBC lavendar/with Diff, and metabolics you should not have a problem with.  An ocassional CEA is needed as well.  I have not personally dealt with medicare but know of many relatives who have not had anthing bad to say that I can remember.  In fact alot of hospitals will except  medicare for payment in full if you meet the low income quaifications criteria. Or the co pay would be extremely low.  Not to be nosey, but if Joe served in the military he could very easily change primary care doctors to a VA Hospital and then get treatment through VA oncology and possibally save alot on meds and outpatient care.  Feel free to e-mail me direct if you would like more infor on this.  You don't have to be a twenty year veteran to recieve medical services through VA.  My uncle spent two years in the Army and uses VA for some out patient and prescription fills. I don't know if I answered anything Mary Anne I guess I'm more of thinking out loud.

God Bless,
Jeff G.

P.S.  I guess I would say anyone fighting this disease and has served in the military for any lenght of time or a period of time when there were conflicts/wars going on should consider checking out qualifications for utilizing a VA medical facility.  Insurance or no Insurance. They have modernized their business side to aline more with private sector.  Couple decades ago it was almost totally free.  Those days are gone.

Take it to the Limit,One More Time! (Eagles)

Re: Does Medicare cover routine chemo drugs like Xeloda and Gemcitibine

Maryanne,
there are only a few chemo drugs and combinations thereof being used for this cancer, and all have appeared with patients on this site.  It might help to have a list of this drugs on hand when conferring with Joe's physician who most likely will have his staff follow-up with your insurance company or, as it was in our case, he made a personal phone call in order to advocate for another treatment protocol. 
Hoping for Joe to be feeling better each dayl
Marions

THIS INFORMATION IS NOT INTENDED NOR IMPLIED TO BE A SUBSTITUTE FOR PROFESSIONAL MEDICAL ADVICE. YOU SHOULD ALWAYS SEEK THE ADVICE OF YOUR PHYSICIAN OR OTHER QUALIFIED HEALTH CARE PROVIDER

Re: Does Medicare cover routine chemo drugs like Xeloda and Gemcitibine

Thanks for your answers.  Jeff, Joe never served in the military becasue he had a heart murmur from Rheumatic Fever as a kid.  So vets is out.  The oncologist said the IV cehmo would be covered but probably not the xeloda.  Has anyone on Medicare been on xeloda and was it covered?  We have checked with Walgreens and joined their no insurance discount plan but now they think we can't be on that if we have Medicare because both are federally funded and one would cancel out the other.  We do not have the Medicare prescription coverage.  Xeloda is expensive but not nearly as bad as the IPT treatments were. 
Any other suggestions would be appreciated.  Thanks so much.  Mary Anne

Re: Does Medicare cover routine chemo drugs like Xeloda and Gemcitibine

my husband was diagnosed  with pancreatic cancer2 years ago this coming june. he had the whipple procedure and all went well with that. he was put on gemicide intervenously  once a week for 3 weeks off 1 week.  he was finally in remisson for a short time and the cancer came back. he is now on xeloda 500 mg  per pill 6 pills per day  for 2 weeks  and 1 week off. the xeloda had shrunk his tumors according to the first cat scan after being put on it. his second cat scan showed no change ---which is good but hoped for more shrinkage, but with this cancer and all cancers you take what  little good news and run with it. he will now be going in for his 3rd cat scan in jan. (as he has them every two months) so we are hoping for more good news........my husband is 75 and medicare was paying for the xeloda 100% but have found out we will be responsible for  20% starting jan. 1st. for 82 pills it costs close to $2,000. well just wanted to talk and let you know what our experience with this dreaded dease is . may god bless and watch over all of you

7 (edited by marions Thu, 17 Dec 2009 02:13:11)

Re: Does Medicare cover routine chemo drugs like Xeloda and Gemcitibine

Dear Nancy....It is nice to meet you and thank you for sharing your story with us.  I am wondering whether you could speak to the office staff at your oncologists office regarding the cost of Xeloda.  The pharmaceutical company (Roche) most likely has a program called "compassionate use" which offers the prescription for no or, minimal cost to those patients earning less than $75.000 per year. (I believe that is the income bracket.) It would be worth checking into.  The members on this board have bile duct cancer which also is called Cholangiocarcinoma, and many also are using Xeloda.  Dear Nancy, the John Hopkins site has a pancreatic cancer chat room which is a great resource for patients with pancreatic cancer.  You might want to go on their board also and connect with patients and caretakers focusing on pancreatic cancer and who most likely will be able to share information pertaining to the disease your husband has.  You may click on the link below:
http://pathology.jhu.edu/n.web?EP=N& … CREAS_CHAT

I am hoping very much for your husband to have continued  success with his treatments and that your Medicare issues will be resolved.
I am sending all my best wishes to you,
Marion

THIS INFORMATION IS NOT INTENDED NOR IMPLIED TO BE A SUBSTITUTE FOR PROFESSIONAL MEDICAL ADVICE. YOU SHOULD ALWAYS SEEK THE ADVICE OF YOUR PHYSICIAN OR OTHER QUALIFIED HEALTH CARE PROVIDER