Cancer Drug Costs

[hodakl]

 Hello, I am a Multiple Myeloma Cancer patient. Recently my dose for the drug Lenalidomide ( a generic for Revlimid ) was reduced from 10mg, 28 day cycle to 5mg, 28 day cycle. I was surprised to find that the retail cost listed by my insurance was the same. Curious as to who sets the price, Drug Company, Distributer? and is this also true for quantity? 

[GailL1]

@hodakl 

What type of “Insurance” are you on - there is a world of difference in employer plans, private plans and Medicare plans.

If it is a Part D Medicare Prescription Drug Plan - the prices are set by negotiations between the insurance company’s Pharmacy Benefits Management and the Drug Company,  

Personally, I would check the receipt from the pharmacy - they may have made an error in the cost or with your new prescription since you were on it before albeit at a higher dose.  Or it could have been between the pharmacy and the insurance company - the pharmacy might not have keyed in the new dose and just “picked the one that was already listed.” 

Just double check.

[hodakl]

Hi GailL1, thank you for the reply. I am enrolled in a Senior Medicare Advantage plan. I have reached out to member services inquiring about the cost difference but no response yet. I am not affected out of pocket financially just curious as to how and who sets drug prices. Old school me remembers if you received less ( dose not quantity in this case ) generally you paid less. With the cost of medical and drug prices increasing curious me just wanting to know why

[AARPConsumerCare]

@hodakl  Thanks for reaching out! I recommend that you check with your Advantage plan to see how your prescriptions are priced. Here is information on what individual states are doing to lower Rx prices through Medicare: https://www.aarp.org/politics-society/advocacy/info-2024/states-target-prescription-drug-costs.html?... You may find more articles on our website also. I wish you the best in your treatments!  Jodee R.