Key takeaways

  • Treatment costs for multiple myeloma are higher than those for many other types of cancer. One reason for this is that multiple myeloma is a chronic condition that may require treatment for years.
  • If your insurance plan does not cover a medication, you can appeal the decision. But even if your medication is covered, you’ll need to pay a deductible, copays, and other associated costs.
  • You may be able to get financial assistance through resources such as nonprofit organizations, prescription assistance programs, or Medicaid. Clinical trials may offer the opportunity to try an experimental treatment at a reduced cost.

Whether you’ve recently received a multiple myeloma diagnosis or you’ve been living with this chronic health condition for some time, managing the costs of your treatment can be a huge challenge.

Chemotherapy, imaging, infusion center fees, and the costs of specialist visits and other medications may leave you feeling anxious. And if you don’t feel well enough to work, you may also be dealing with a loss of income.

The last thing you should have to worry about when you are sick is where the money is going to come from to pay your medical bills. There are many resources you can turn to for help.

The costs of treatment for multiple myeloma are higher than the treatment costs for most other types of cancer. And these costs have increased as the prices of drugs, outpatient treatments, and hospital stays have also gone up.

Your doctor might recommend both chemotherapy and long-term oral drugs that you may need to take indefinitely. Plus, you’ll have specialist visits, lab work, and imaging, along with travel costs to get to the treatment center.

Like other types of cancer, multiple myeloma has a lot of direct costs attached to it. The drugs to treat it typically cost around $100,000 per year, and combination drug regimens can total as much as $300,000 to $600,000 per year.

Since multiple myeloma is a chronic disease, long-term drug therapy is likely. People with multiple myeloma tend to continue treatment for years and sometimes indefinitely.

Navigating your health insurance can be stressful, but learning some key terms can make the whole process easier. Here are some to keep in mind:

  • Deductible: This is the amount of money you must pay out of pocket each year before the insurance company will cover medical bills.
  • Copayments (copays): Copays are the dollar amounts you pay at the time of service for medical services and prescription drugs. These costs are not applied against your insurance plan’s deductible.
  • Coinsurance/cost share: This is the percentage of your medical expenses that you and your health plan share. You’ll pay these costs in addition to copays and deductibles.
  • Out-of-pocket maximum: This is the limit on the total amount you pay per year.

Drugs to treat multiple myeloma are expensive. When communicating with your insurance company about a drug that your doctor wants you to take, you can request a formulary exception if the drug is not covered. If your insurance company denies coverage, you can appeal the decision.

If your insurer still denies coverage, you can ask your doctor to recommend a specialty pharmacy case manager who can help coordinate your drug coverage.

Some drug manufacturers offer prescription assistance programs. These companies may offer free or reduced-cost medications to people who are both insured or uninsured. For a list of patient prescription assistance programs, you can visit RxAssist.

If you are on Medicare, you may get information about drug coverage, as well as information on Extra Help and how to make an appeal if a claim is denied. You can call 800-MEDICARE to find out if you qualify for Medicare Extra Help.

If you’re eligible for Medicaid, Medicaid may cover some costs that Medicare does not.

A number of organizations offer financial assistance and support to people who are living with multiple myeloma:

You can also look for multiple myeloma trials at ClinicalTrials.gov. Participating in a trial may allow you to access new treatments at a reduced cost.

Make friends with your doctor, nurse, social worker, and billing clerk, as well as other people you see at your treatment appointments. These are the people in the best position to advocate for you.

Develop a relationship with the case manager at your insurance company so you can always talk to the same person when you call. And find out if your employer has a benefits advisor or an advocate who can help you.

Be sure to follow your insurance company’s rules when it comes to treatment. For instance, you may need to call a toll-free number before a hospital admission. Blood Cancer United advises that you check whether pre-authorization or pre-certification is needed before any treatments or procedures.

And learn about the laws that are meant to protect patients and ensure continuation of medical coverage, such as the Affordable Care Act (ACA), the Consolidated Omnibus Budget Reconciliation Act COBRA), and the Americans with Disabilities Act (ADA).

If you are unable to work, you may be eligible for Social Security Disability Insurance, which may provides monthly income if you qualify.

Figuring out how to pay for your ongoing treatment for multiple myeloma can be stressful to say the least, but there are plenty of resources that you can tap into along the way.

Assistance comes in many forms, from nonprofit organizations that offer grants to oncology social workers who can help you figure out where to look and how to apply for financial assistance.