print pagefont size

True or False

Learn the truth about common misconceptions of reimbursement.

Get answers to the most common reimbursement myths.

  1. If I am a Medicare patient, my out-of-pocket expenses will be the same for all of the drugs I take as part of my treatment regimen.

    True/False?
    FALSE. Different types of medications are handled by different segments of the Medicare program. Medications are typically covered under either Part B or Part D. Ask your doctor or the office staff under which segment of Medicare your medication will be handled.

    Medicare Part B
    A medication that is given intravenously is usually administered in a physician’s office or hospital outpatient clinic. Therefore, it is reimbursed under Part B (the medical insurance part of Medicare), and you would typically pay the first $162 yearly deductible and then 20% of any remaining Medicare approved amount for the service.

    If you have a supplemental policy, it may pay the 20% and in some cases, depending on the plan, the annual deductible.

    VELCADE® (bortezomib) is administered intravenously, and is therefore typically covered under Medicare Part B.

    Medicare Part D
    Other types of medications may be covered under Medicare Part D, the Medicare prescription drug benefit. The Part D benefit for 2011 includes an annual deductible, monthly premiums, co-insurance, a coverage gap, and catastrophic coverage.

    In 2011, the standard prescription drug benefit works this way: you have to pay an annual deductible of $310. You then move into a co-insurance category until you reach $2,840 in covered Part D drug spending. Your insurance plan pays 75% of the cost of the medication in this category, and you are responsible for paying 25% (up to a maximum of $632.50).

    From there, you go into what is referred to as the "coverage gap" or "doughnut hole" for the next $3,607.50 in covered Part D drug spending. Prior to 2011, you would have paid 100% of the cost within the coverage gap. Starting in 2011, eligible Medicare Part D beneficiaries whose spending on Part D prescription drugs enters them into the coverage gap will receive a 50% manufacturer discount on the total cost of brand-name drugs and a 7% government subsidy on the total cost of generic drugs within the coverage gap.

    Once you get out of the coverage gap (generally after $6,447.50 in covered Part D drug spending), you are in what is referred to as “catastrophic coverage.” You will now be responsible for paying 5% of the cost of your drug. The prescription drug benefit described above starts over at the beginning of each year.

    Medicare Part D Benefits
    Benefit Phase Beneficiary Cost-Sharing Percentage Maximum Beneficiary Out-of-Pocket (OOP) Costs per Phase Plan Payment Percentage Plan Payment
    Annual Deductible
    $0 - $310 in spending on covered Part D drugs
    100% $310 0% $0
    Initial Benefit
    $310.01 - $2,840 in spending on covered Part D drugs
    25% $632.50 75% $1,897.50
    No coverage of costs
    $2,840.01 - $6,447.50 in spending on covered Part D drugs*
    100%* $3,607.50* 0% $0
    Catastrophic Coverage after patient OOP costs on covered Part D drugs exceed $4,550; generally equivalent to $6,447.50 in covered Part D drug spending 5% Unlimited 95% Unlimited

    *Starting in 2011, eligible Medicare Part D beneficiaries whose spending on Part D prescription drugs enters them into the coverage gap will receive a 50% manufacturer discount on the total cost of brand-name drugs and a 7% government subsidy on the total cost of generic drugs within the coverage gap.


  2. All co-pay foundations provide help for all patients.

    True/False?
    FALSE. Co-payment foundations receive donations from individuals, corporate sponsors, and foundations that are specific to a particular diagnosis. The VELCADE Reimbursement Assistance Program (VRAP) can tell you which co-payment foundations have available funding for multiple myeloma and relapsed mantle cell lymphoma (MCL). You can contact VRAP at 1-866-VELCADE (835-2233), option 2.

    Other important information to remember about co-payment foundation assistance:

    • Co-payment foundations can provide partial or full financial assistance to eligible patients. The amount of assistance that you may receive depends on a number of factors, including: the amount of funding available, the actual co-payments you will incur within one year, your income, and your insurance coverage
    • Co-payment foundations cannot specify that assistance be made available by route of administration—oral, intravenous, or injectable. All drugs that are approved by the FDA for the funded disease state are available for co-payment assistance
  3. Medigap policies cover co-pays under Medicare Part B.

    True/False?
    TRUE. A Medigap policy is designed to supplement the benefits of Medicare. This means it helps pay some of the healthcare costs or gaps that Medicare doesn’t cover. Most Medigap policies cover Medicare Part B co-payments and co-insurance amounts. There are some Medigap polices that also cover the annual Part B deductible.

  4. If my insurance plan will not pay for VELCADE, there is nothing more I can do.

    True/False?
    FALSE. VELCADE is generally covered by all insurance plans. However, if your insurance will not pay for VELCADE, your physician can call the VELCADE Reimbursement Assistance Program (VRAP) for additional information, resources, and/or potential sources of financial assistance. Your physician can contact VRAP at 1-866-VELCADE (835-2233), option 2.

  5. I can use my Medigap policy with Medicare Advantage (formerly known as Part C) to pay for my deductible and co-payments.

    True/False?
    FALSE. If you have a Medicare Advantage Plan, your Medigap policy cannot be used to pay your Medicare Advantage Plan co-payments and deductibles.

  6. All Medicare Advantage plans cover prescription drugs without an additional cost to me.

    True/False?
    FALSE. Medicare Advantage Plans provide all of your Part A (Hospital Insurance), Part B (Medical Insurance) coverage, and occasionally Part D (Prescription Drug Coverage). Medicare Advantage Plans with prescription drug coverage are sometimes called “MA-PDs.” Prescription drug coverage included in these plans usually costs an additional amount.

  7. VELCADE is only covered by the Medicare program and not by Medicaid or a private/commercial plan.

    True/False?
    FALSE. VELCADE is usually covered by all payers— Medicare, Medicaid, and private/commercial plans—for its indications approved by the FDA. The VELCADE Reimbursement Assistance Program (VRAP) can assist you and your physician by calling your insurance plan and verifying coverage for VELCADE. You and/or your physician can contact VRAP at 1-866-VELCADE (835-2233), option 2.

NEXT: Resources

Medicare

Government program that provides insurance coverage to elderly individuals and individuals in several other eligibility categories. Medicare is a federal program.

Medicaid

Government program that provides insurance coverage to low income individuals who meet certain eligibility requirements. Medicaid programs vary from state-to-state.

Reimbursement

The process of paying for healthcare services, supplies, and medications. Insurance plans, the government, and patients reimburse healthcare providers and pharmacies for the services and products they provide

Deductible

The amount that a patient must pay of his/her medical expenses before insurance benefits are applied, typically calculated on an annual basis. Amounts defined by a patient’s insurance benefit structure.

Co-Payment

Fixed amount of money a patient is responsible for at each doctor’s visit, at the hospital or emergency room, or when a prescription is filled at a pharmacy (i.e. $10, $20, etc.). Amounts defined by the patient’s insurance benefit structure.

Co-Insurance

Percent of the allowable charges a patient is responsible for (i.e. 15%, 20%, etc.), as defined in the patient’s insurance benefit structure

Coverage Gap

Applies to the Medicare Part D (prescription drug) benefit wherein the beneficiary is responsible for 100% of the costs of the covered Part D drug prescriptions he/she fills. The coverage gap takes effect when total spending in a calendar year on covered Part D drugs reaches $2,700 and ends when the total reaches $6,153.75, equating to a total out-of-pocket expense of $3,453.75 while the beneficiary is in the coverage gap. The coverage gap only applies to covered Medicare Part D drugs (i.e. prescriptions filled at the pharmacy) and not to Medicare Part B drugs (i.e. drugs administered intravenously in a physician’s office).

Doughnut Hole

Applies to the Medicare Part D (prescription drug) benefit wherein the beneficiary is responsible for 100% of the costs of the covered Part D drug prescriptions he/she fills. The coverage gap takes effect when total spending in a calendar year on covered Part D drugs reaches $2,700 and ends when the total reaches $6,153.75, equating to a total out-of-pocket expense of $3,453.75 while the beneficiary is in the coverage gap. The coverage gap only applies to covered Medicare Part D drugs (i.e. prescriptions filled at the pharmacy) and not to Medicare Part B drugs (i.e. drugs administered intravenously in a physician’s office).

Medigap

Health insurance sold by a private company to help Medicare Part A and Medicare Part B patients pay for their out-of-pocket expenses. Also referred to as “supplemental insurance.”

Out-Of-Pocket Expenses

The total of a patient’s co-payment amounts, co-insurance amounts, and deductibles. Does not include a patient’s monthly premium for an insurance plan.


Important Safety Information

What is VELCADE® (bortezomib) used for?

VELCADE is approved for the treatment of patients with multiple myeloma (a cancer of the plasma cells). VELCADE is also approved for the treatment of patients with mantle cell lymphoma (a cancer of the lymph nodes) who have already received other treatments.

How is VELCADE administered?

VELCADE is prescribed by a physician experienced in the use of medications to treat cancer. It is administered by a healthcare professional as an injection into your vein (intravenously, or IV) or under your skin (subcutaneously). VELCADE must not be administered into your spinal fluid (intrathecally).

Who should not receive VELCADE?

Before you receive treatment with VELCADE, tell your doctor about all of your medical conditions. You should not receive VELCADE if you are allergic to bortezomib, boron, or mannitol.

What are the possible side effects of VELCADE?

VELCADE can cause serious side effects, including:

  • Peripheral neuropathy. VELCADE can cause damage to the nerves, a condition called peripheral neuropathy. You may feel muscle weakness, tingling, burning, pain, and loss of feeling in your hands and feet, any of which can be severe. Tell your doctor if you notice any of these symptoms. Your doctor may change the dose and/or schedule of VELCADE, or stop it altogether. If you have peripheral neuropathy before starting VELCADE, your doctor could consider giving you VELCADE subcutaneously.
  • Low blood pressure. VELCADE can cause a drop in blood pressure. Tell your doctor if you have low blood pressure, feel dizzy, or feel as though you might faint. If you are taking drugs that lower blood pressure, your medications might need to be adjusted. If you are not drinking enough liquids, your doctor may need to administer IV fluids.
  • Heart problems. Treatment with VELCADE can cause or worsen heart rhythm problems and heart failure. Your doctor may closely monitor you if you have, or are at risk for, heart disease. Tell your doctor if you experience chest pressure or pain, palpitations, swelling of your ankles or feet, or shortness of breath.
  • Lung disorders. There have been reports of lung disorders in patients receiving VELCADE. Some of these events have been fatal. Tell your doctor if you experience any cough, shortness of breath, wheezing, or difficulty breathing.
  • Liver disease. If you have liver problems, it can be harder for your body to get rid of VELCADE. VELCADE has caused sudden liver failure in patients who were taking many medications or had other serious medical conditions. Symptoms of liver problems include a yellow discoloration of the eyes and skin (jaundice) and changes in liver enzymes measured in blood tests. Your doctor will closely monitor you if you have liver disease. In patients with moderate or severe liver disease, VELCADE should be started at a lower dose. Additional dose adjustments may be made based on your tolerance of the drug.
  • Gastrointestinal problems. VELCADE treatment can cause nausea, vomiting, diarrhea, and constipation. If your symptoms are severe, your doctor may recommend IV fluids and/or medications.
  • Neutropenia (low levels of neutrophils, a type of white blood cell) and thrombocytopenia (low levels of platelets). VELCADE can cause low levels of white blood cells (infection-fighting cells) and/or platelets (clot-forming cells). You will have regular blood tests to check your cell counts during your treatment with VELCADE. If the number of these cells is very low, your doctor may change the dose and/or schedule of VELCADE. If your white blood cells become low, you can be at higher risk for infections. Tell your doctor if you develop a fever or believe you have an infection. If platelets become very low, there is an increased risk of bleeding. Your doctor may recommend a platelet transfusion. There have been cases of bleeding in the stomach, bowels, and brain during treatment with VELCADE.
  • Tumor lysis syndrome (TLS). TLS can occur with cancer treatments, and your doctor will be monitoring your blood and urine for any signs of this syndrome. If you develop TLS, your doctor will take appropriate steps to treat it.
  • Reversible posterior leukoencephalopathy syndrome (RPLS). There have been reports of a rare, reversible condition involving the brain, called RPLS, in patients treated with VELCADE. Patients with RPLS can have seizures, high blood pressure, headaches, tiredness, confusion, blindness, or other vision problems. Treatment with VELCADE should be stopped in cases of RPLS.

More than 30% of patients receiving VELCADE have experienced the following side effects: thrombocytopenia, neutropenia, nausea, peripheral neuropathy, neuralgia (nerve pain), pyrexia (fever), diarrhea, anemia, leukopenia (low levels of white blood cells), decreased appetite, fatigue, constipation, vomiting, dehydration, dyspnea (difficulty breathing), cough, asthenia (low energy), insomnia (trouble sleeping), peripheral edema (swelling of the limbs), and headache.

What other information should you discuss with your doctor?

Women should avoid becoming pregnant or breastfeeding while being treated with VELCADE. Discuss with your doctor when it is safe to restart breastfeeding after finishing your treatment.

You should also tell your doctor if you:

  • Have kidney disease. If you are on dialysis, your doctor will administer VELCADE after the dialysis procedure.
  • Are taking medication for diabetes. VELCADE can affect your blood glucose levels. Your doctor may require close monitoring of your blood glucose levels and change the dose of your diabetes medicine while you are being treated with VELCADE.
  • Have liver disease.
  • Are using medicines like ketoconazole (an antifungal), ritonavir (an antiviral), and rifampin (an antibiotic), which will require close monitoring during treatment with VELCADE.
  • Are using any other medications (including over-the-counter drugs), herbal or dietary supplements, or holistic treatments. St. John’s Wort should be avoided.
  • Develop a rash of any type while receiving VELCADE.

The side effects of VELCADE may impair your ability to drive or operate machinery.

These are not all of the possible side effects with VELCADE. It is important to always contact your doctor if you experience any side effects while on VELCADE. If you have any questions about VELCADE, contact your doctor.

Please click here for the full Prescribing Information for VELCADE, including Warnings and Precautions.

Page last updated 1/23/2012

Learn what to expect from treatment with VELCADE.
Important Safety Information
What is VELCADE® (bortezomib) used for?

VELCADE is approved for the treatment of patients with multiple myeloma (a cancer of the plasma cells). VELCADE is also approved for the treatment of patients with mantle cell lymphoma (a cancer of the lymph nodes) who have already received other treatments.

How is VELCADE administered?

VELCADE is prescribed by a physician experienced in the use of medications to treat cancer. It is administered by a healthcare professional as an injection into your vein (intravenously, or IV) or under your skin (subcutaneously). VELCADE must not be administered into your spinal fluid (intrathecally).

Who should not receive VELCADE?

Before you receive treatment with VELCADE, tell your doctor about all of your medical conditions. You should not receive VELCADE if you are allergic to bortezomib, boron, or mannitol.

What are the possible side effects of VELCADE?

VELCADE can cause serious side effects, including:

  • Peripheral neuropathy. VELCADE can cause damage to the nerves, a condition called peripheral neuropathy. You may feel muscle weakness, tingling, burning, pain, and loss of feeling in your hands and feet, any of which can be severe. Tell your doctor if you notice any of these symptoms. Your doctor may change the dose and/or schedule of VELCADE, or stop it altogether. If you have peripheral neuropathy before starting VELCADE, your doctor could consider giving you VELCADE subcutaneously.
  • Low blood pressure. VELCADE can cause a drop in blood pressure. Tell your doctor if you have low blood pressure, feel dizzy, or feel as though you might faint. If you are taking drugs that lower blood pressure, your medications might need to be adjusted. If you are not drinking enough liquids, your doctor may need to administer IV fluids.
  • Heart problems. Treatment with VELCADE can cause or worsen heart rhythm problems and heart failure. Your doctor may closely monitor you if you have, or are at risk for, heart disease. Tell your doctor if you experience chest pressure or pain, palpitations, swelling of your ankles or feet, or shortness of breath.
  • Lung disorders. There have been reports of lung disorders in patients receiving VELCADE. Some of these events have been fatal. Tell your doctor if you experience any cough, shortness of breath, wheezing, or difficulty breathing.
  • Liver disease. If you have liver problems, it can be harder for your body to get rid of VELCADE. VELCADE has caused sudden liver failure in patients who were taking many medications or had other serious medical conditions. Symptoms of liver problems include a yellow discoloration of the eyes and skin (jaundice) and changes in liver enzymes measured in blood tests. Your doctor will closely monitor you if you have liver disease. In patients with moderate or severe liver disease, VELCADE should be started at a lower dose. Additional dose adjustments may be made based on your tolerance of the drug.
  • Gastrointestinal problems. VELCADE treatment can cause nausea, vomiting, diarrhea, and constipation. If your symptoms are severe, your doctor may recommend IV fluids and/or medications.
  • Neutropenia (low levels of neutrophils, a type of white blood cell) and thrombocytopenia (low levels of platelets). VELCADE can cause low levels of white blood cells (infection-fighting cells) and/or platelets (clot-forming cells). You will have regular blood tests to check your cell counts during your treatment with VELCADE. If the number of these cells is very low, your doctor may change the dose and/or schedule of VELCADE. If your white blood cells become low, you can be at higher risk for infections. Tell your doctor if you develop a fever or believe you have an infection. If platelets become very low, there is an increased risk of bleeding. Your doctor may recommend a platelet transfusion. There have been cases of bleeding in the stomach, bowels, and brain during treatment with VELCADE.
  • Tumor lysis syndrome (TLS). TLS can occur with cancer treatments, and your doctor will be monitoring your blood and urine for any signs of this syndrome. If you develop TLS, your doctor will take appropriate steps to treat it.
  • Reversible posterior leukoencephalopathy syndrome (RPLS). There have been reports of a rare, reversible condition involving the brain, called RPLS, in patients treated with VELCADE. Patients with RPLS can have seizures, high blood pressure, headaches, tiredness, confusion, blindness, or other vision problems. Treatment with VELCADE should be stopped in cases of RPLS.

More than 30% of patients receiving VELCADE have experienced the following side effects: thrombocytopenia, neutropenia, nausea, peripheral neuropathy, neuralgia (nerve pain), pyrexia (fever), diarrhea, anemia, leukopenia (low levels of white blood cells), decreased appetite, fatigue, constipation, vomiting, dehydration, dyspnea (difficulty breathing), cough, asthenia (low energy), insomnia (trouble sleeping), peripheral edema (swelling of the limbs), and headache.

What other information should you discuss with your doctor?

Women should avoid becoming pregnant or breastfeeding while being treated with VELCADE. Discuss with your doctor when it is safe to restart breastfeeding after finishing your treatment.

You should also tell your doctor if you:

  • Have kidney disease. If you are on dialysis, your doctor will administer VELCADE after the dialysis procedure.
  • Are taking medication for diabetes. VELCADE can affect your blood glucose levels. Your doctor may require close monitoring of your blood glucose levels and change the dose of your diabetes medicine while you are being treated with VELCADE.
  • Have liver disease.
  • Are using medicines like ketoconazole (an antifungal), ritonavir (an antiviral), and rifampin (an antibiotic), which will require close monitoring during treatment with VELCADE.
  • Are using any other medications (including over-the-counter drugs), herbal or dietary supplements, or holistic treatments. St. John’s Wort should be avoided.
  • Develop a rash of any type while receiving VELCADE.

The side effects of VELCADE may impair your ability to drive or operate machinery.

These are not all of the possible side effects with VELCADE. It is important to always contact your doctor if you experience any side effects while on VELCADE. If you have any questions about VELCADE, contact your doctor.

Please click here for the full Prescribing Information for VELCADE, including Warnings and Precautions.