Cost of Rituxan....

I just got my EOB for my low dose Rituxan treatment. I had the equivalent of 4 low dose tx (400 mg) in one sitting both because of the convenience factor and to try to keep the cost down.

The insurance company was billed over $13,000 by the hospital. The "allowed" or adjusted amount is $4140. All I can say is I'm glad I have insurance....

Imagine what the standard dose would have been! ~2800 mg vs. 400 mg

Just one example of why our healthcare costs are spiraling out of control. I doubt patients would be so quick to agree to the "standard dose" if they were paying even a percentage.

A lot of posters here seem to be of the mindset that if the doctor orders it, it must be the best, and that the 4 standard doses must be done weekly. Why not go 2-3 weeks between doses, and why not stop when you start responding? I don't get it.

FWIW, I have a $2000 yearly deductible, so I have burned through it for 2015 and will now make good use of only having copays for the rest of the calendar year for visits I think are warranted. Doubt I'll be having more rituxan, but if I do, it'll be before Dec 31.

Medical costs are ridiculous! We are in the midst of a major insurance monopoly in our area. You either take UPMC insurance or you have no access to doctors or hospitals. Their plan options are horrible, even the best one. They have such a great reputation, but I know people who work there and they tell me what really goes on. Patient care comes last. You really want to be the first scheduled in the OR each day or you get used surgical equipment. That's only one example.

It's horrible that hospitals bill one amount but accept much less from insurance companies. It wouldn't be so bad but they bill patients the higher amount if they are not insured.

Tamar, hopefully more information about Rituxan will come out soon, and protocol will change. Then the problem will be to educate doctors who have no clue. I've been working with the PDSA re these things and they are well aware of the horror stories. I don't know what it will take to get things to change.

Sandi wrote: Medical costs are ridiculous! We are in the midst of a major insurance monopoly in our area. You either take UPMC insurance or you have no access to doctors or hospitals. Their plan options are horrible, even the best one. They have such a great reputation, but I know people who work there and they tell me what really goes on. Patient care comes last. You really want to be the first scheduled in the OR each day or you get used surgical equipment. That's only one example.

It's horrible that hospitals bill one amount but accept much less from insurance companies. It wouldn't be so bad but they bill patients the higher amount if they are not insured.

Tamar, hopefully more information about Rituxan will come out soon, and protocol will change. Then the problem will be to educate doctors who have no clue. I've been working with the PDSA re these things and they are well aware of the horror stories. I don't know what it will take to get things to change.

I'm sure it will come as no surprise that there are 4 lines on my EOB that are billed at $45-$50 where the insurance company only allows <$1. My guess is those lines are for things like tylenol. It is no wonder people without insurance are in danger of bankruptcy.

The games these people play!
I'm having insurance issues at the moment. The very most my insurer says I should pay for NPlate is $500 per calendar year. If Amgen admits me into their copay plan, my responsibility should be 0. No one has ever told me whether I'm in their program or not. Amgen hasn't informed me, and the last time I asked the MD office person if she'd heard, she said she'd left four messages at the company and could not get a response.

Saturday, I got an invoice from the MD for $2900 for the month of January.
Assume February will be the same, but I haven't gotten that bill yet. They want me to provide a copay of $965 for each weekly shot back to the first of 2015. And they're starting to hint that I might not be getting more shots until someone tells them who's going to pay.
Between the union's benefits office, the MD's office staff, and Amgen's non-cooperation... It's all a big standoff with me in firing range.

I had the full 4x dose in 2009 and the EOB came it at around 50k - I can only imagine what it would be today.

Being Self-employed I get to pay for my insurance myself and the best plan I can get has a $6800 deductable. Thankfully I am in the "watch and see" mode and I just pray I don't have to treat (Prednisone and me - I have had my lifetime share of it - no more!!!)

My sister just got her EOB and her three infusions were about $67,000.

This is precisely why I now 'settle' for using Cellcept, living with low numbers, but only paying $10 a month co-pay.
Gaining another 10k doesn't do me any good, if we lose our house in the process.

I read an interesting article yesterday...need to find it again. Basically it stated that currently in the USA;
1% of all drugs sold are 'specialty drugs', yet those drugs account for 31% of the money made by the drug companies.
I doubt they are going to lower prices; 1/3 of their revenue from 1% of sales? Wow.

But never fear, the Affordable Care Act will solve everything. :S

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Janet, that is very disturbing. What a mess!

Your post reminded me about my last round of Rituxan and the process of qualifying for the manufacturers compassion program.

I was on a three way call with the compassion program and my insurance. After listening to them talk for a while I interrupted and asked for clarification. At that point the manufacturer realize my insurance company had a $2,000.00 max per year that didn't even cover 1 dose.

I have said from day one if I lived in a country where I had to pay for all my treatments I would of been dead years ago!

I was lucky, I didn't have to pay for my Rituxan. Cost wasn't even discussed.

Just goes to show how different countries are and even how different the Provinces are here in Canada.

$14235 a week. Amazed that insurance picked it up @100%.

In 2007 and 2009 my bill for Rituxan was 12,500 per infusion. Insurance paid for it. My doctor coded it as something cancer-ish which I'm sure helped.

I received 4 doses at a cost of $3,850.00 each, my insurance covered 80% and the drug company paid 20%.
Last dose was 6 weeks ago and my platelets are still at 17000, no improvement at all.

I had four doses also. This is week 5 and my platelets continue to drop. Had a nose bleed yesterday so I feel confident that they haven't gone up over the weekend. Very frustrating. People say it can take some time, but it sure it hard to be patient! Keep us posted.

I'm now making payments to the hematologist for the WinRho treatment that did absolutely nothing. I was rejected for financial assistance for the Rituxan. They ordered Gammagard and I told them they can order if but I'm not going to agree to take it unless I can get financial assistance. All the tier 5 drugs have co-payments between 3k and 5k for one set of treatments. At what point is this becoming silly? I'm thinking of asking the doctor to consider an Immunosuppressant which I could actually pay for. I'm wondering at what point I need to find another doctor. It seems like all we are doing is looking at tier 5's which I can't pay for.

I was at that point at one time too. I had five Win-Rho treatments with high co-pays that didn't work at all. I finally gave up and went to steroids because they were cheap. I had two kids in college and viewed the money for those treatments as nothing but a waste.

You can make suggestions to your doctor and advocate for yourself. I've done it. If they agree, problem solved. If not, time to go doctor hunting.

I'm thinking of asking the doctor to consider an Immunosuppressant which I could actually pay for. I'm wondering at what point I need to find another doctor. It seems like all we are doing is looking at tier 5's which I can't pay for.

I feel your pain! Been there...heck, I am still there.....
When I was taking Promacta at an $80 monthly co-pay, I could afford it. As soon as that changed to annual my max-out-of-pocket paid up-front ($5,500)...I stopped taking it. My hematologist works with me on this.
There are other treatments out there which cost far less. They may not work quite as well, but I'd rather keep my home and use something that is less effective to treat ITP. So the numbers are a little lower....not a big deal.

There are options......Life continues.

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When you get on Medicare, things can get even worse! It depends on how you get your medication--that determines your cost (if you can figure it out!). If it's in the doctor's office or hospital setting, I think it comes under Part B. if it is out-patient or at your home, I think you can pay up to the maximum out-of-pocket which is probably close to $5,000 per year. This is only your medication part of your expenses. Then, the doctor's/hospital co-pays come under and different tiered plan. I chose the Supplement which will pay for more, but you make monthly payments.

DeeDee Marie wrote: When you get on Medicare, things can get even worse! It depends on how you get your medication--that determines your cost (if you can figure it out!). If it's in the doctor's office or hospital setting, I think it comes under Part B. if it is out-patient or at your home, I think you can pay up to the maximum out-of-pocket which is probably close to $5,000 per year. This is only your medication part of your expenses. Then, the doctor's/hospital co-pays come under and different tiered plan. I chose the Supplement which will pay for more, but you make monthly payments.

True. I take NPlate primarily because it's under the medical Part B instead of the drug plan D. My plan picks up almost all the NPlate related expenses. If I took Promacta, it would cost me loads more under the drug plan Part D.
One thing I think is odd... A doctor must be on the premises when I get my shot, even though only a nurse is involved in the administration. That's government for you... :dry:

That alone is a good reason to take N-Plate over Promacta!! I know a while back they were experimenting with people learning to give their own shots at home. I'm glad that hasn't happened so far--this way the cost stay within reach. I'm glad you mentioned this.

You may be able to get financial assistance from Genentech
www.genentech-access.com/hcp/learn-about-our-services

I was denied the first time and my doctor re-applied and I was accepted.

So glad we still have an NHS in the UK