As a Financial Coach with the Myeloma Coach program, I am in frequent contact with myeloma patients and caregivers, especially regarding their financial concerns and challenges. Recently there have been a variety of questions/concerns shared with me related to individuals on Medicare. Specific concerns were expressed regarding coverage of procedures and treatment as well as eligibility to receive financial assistance from Bristol Myers Squibb. Keep reading for an update on these important financial issues.  

Bristol Myers Squibb

I have had some concerns posed to me regarding Bristol Myer Squibb's patient financial assistance, especially from individuals on Medicare. I want to assure everyone- assistance is available,  and provide an update of Bristol Myers Squibb's current policies. Their website is a bit confusing because it doesn’t specifically refer to granting financial help to Medicare patients. There has been a minor change, but other than that it remains available to those who qualify.

Since Bristol Myers Squibb finalized the purchase of Celgene in June their applications for financial assistance are routed a bit differently. Now when you fill out an application, they are going to verify that you, the patient, have sought financial assistance from other sources such as Leukemia Lymphoma Society, Patient Assistance Foundation and Health Well Foundations. Previously,  after gathering the necessary information the application was simply approved or denied.  The current process however has more steps. Once the documents are submitted, they are routed to another department where they verify the information and make a determination. Medicare patients remain eligible for assistance as long as they have met all of the requirements.

Medicare Coverage for PET scans

Another concern that has been shared with me is the number of PET scans that an individual with myeloma may get in a lifetime. After speaking to several people in both The Centers for Medicare & Medicaid Services as well as the Medicare Claims Determination, I have found that there are no limits to the number of PET scans that can be done per patient. That being said, after reading the latest finalized sections of The Centers for Medicare & Medicaid Services document, a lot is left up to the doctor to determine if the procedure is really necessary or if there are other procedures that can replace the PET. Unfortunately, it would seem that one can get a different answer depending on who and how many people you speak with. I would think it a good idea to get in writing that a PET scan is going to be covered before having the procedure being done. Most oncologists having requested a PET for many patients should know if it is covered. Reach out to your insurance company to speak to a representative there.

Medicare Coverage for Stem Cell Transplant

The other question/concern that has been shared with me is, "If a patient has their stem cells collected and then used at a later date would Medicare pay for the collection?" Medicare will generally cover the procedure for this. Another question, will Medicare pay for stem cell transplants for myeloma? The Centers for Medicare & Medicaid Services records show they will only pay if the patient is diagnosed at a Durie Stage II or III. I know this is based on old research. Again, one should check with the insurance that you have. There have been patients that have been declined but when the doctor offers this as the best plan for the patient, they have been known to pay for the procedure especially if one is a high-risk patient. Again, call your insurance to verify and then get a copy of the approval or denial of claim prior to the procedure being done.

Medicare Open Enrollment

The Myeloma Crowd Community Events will be hosting a live Q and A on Oct. 5th at 1:00 EST where I will be available to answer your questions about Medicare open enrollment. This can be a confusing time for many and the decisions made will have a lasting impact. Register here to attend. You may also reach out to Aon insurance company. If you are retired you can review enrollment options with them here.

• Access the 2022 Medicare and You 2022 Booklet in different formats at: www.medicare.gov
• Access the 2022 Medicare Advantage Rate book and Prescription Drug rate book: www.cms.gov