Brown bagging chemotherapy drugs

Yikes
Teri,

I'm so sorry that you two find yourselves in this position. I am on the same protocol.

Undoubtably, it's the Avastin that is costing so much. It's still under patent. Genentech has a ridiculous "Avastin Patient Assistance program" that will rebate a small amount of money after you spend a fortune out of pocket. I think it's total bs, but may be worth a look...

http://www.genentechaccesssolutions.com/portal/site/AS/

If his insurance has firm caps, then he may find himself needing to have his onc look for a substitute for the Avastin. And that sucks.

I hope things work out, please keep us posted.

Strength and love,

Ray

Brownbagging Chemo Drugs
The billed amount has almost nothing to do with the negotiated payment. That said I had Avastin only for 2 years and the billed amount (including nurses etc) was around $9000 every 3 weeks. What was negotiated and paid was less.

Something is way wrong with $47000 per treatment. You really need to call the insurance company and see what is going on. My company is also self insured - that doesn't mean the billed rate has anything to do with the actual payment. But, I have NEVER heard of anything like $47,000 - can't blame Avastin or anything else for that.

Betsy

Buckwirth said:

Billed and Negotiated
This is important, at least to this conversation.

Each insurance company pays a different amount for each treatment, procedure or drug. If the doctor bills to the lowest payer, every insurance company will pay at that lower billed amount, and the doctor misses out on potential income.

To prevent this, they bill above what the highest amount is. Now it is hard to believe that there is an insurance company that will pay $47,000 per treatment for Folfox/Avastin, but by billing this much the doc assures he will get paid the maximum negotiated amount by each insurer.

Normally self-insured companies work with a major insurance company to manage their policy, work the negotiations and determine what is/isn't covered. Is it possible that someone in the office saw the bill and does not understand how this works?

If that is not the case, someone should contact the Oncologist and work out a negotiated fee, I can pretty much promise it will be far less than $47k.

other brownbag options
This kind of "bill and negotiate" should be treated as a form of fraud and extortion of both the vulnerable group and upon society. In other countries, "nominal" pricing like this means doing without for 99.9% of the population - at best an expensive distraction. Such ridiculous "bill and negotiate" creates ruinous uncertainty at many levels and shows the abusive monopoly pricing position or power of group think locked into overchannelized FDA enforced medicine, ignoring many forms, levels and sources of evidence.

If I just read recent news splashes for more economic treatment components with competitive or more promising results, I suppose I would be looking directly at GOLFIG, too.

In actuality, we've followed Japanese research papers (CIM+UFT+LV+PSK+K2/MK4 perioperatively) and some biochemically oriented alternative medicine groups (e.g. LEF, Riordan Clinic) with biomarkers and lab testing for determining some treatment components(CIM+5FU+K2/MK4+aspirin), as well as other supernutritional support (e.g. PSK+D3+lipoic+B3+B6+IVC+coQ10+fish oil). [Note: we use chemistry to prevent spread and to chase (sub)microscopic sites; we use surgery to directly attack macroscopic biomass even if normally considered non-operable; however we have pathological evidence of 90-100% necrosis at different sites]

After that I try to keep a ready research list of possible next moves specific to my wife's situation with reading research for new components of interest or in development. Finding clinical results and decoding John23's TCM herbals for immunotherapies, enzyme inhibitors and pathways is nearly on my to do list.

At least our doctors think our results with this approach are way ahead of their normal game, at 97+% discount (including "medical tourism," or refugees) from "normal" with longer and much better QoL.

TANSTAAFL, per Heinlein

Betsydoglover said:

Brownbagging Chemo Drugs
The billed amount has almost nothing to do with the negotiated payment. That said I had Avastin only for 2 years and the billed amount (including nurses etc) was around $9000 every 3 weeks. What was negotiated and paid was less.

Something is way wrong with $47000 per treatment. You really need to call the insurance company and see what is going on. My company is also self insured - that doesn't mean the billed rate has anything to do with the actual payment. But, I have NEVER heard of anything like $47,000 - can't blame Avastin or anything else for that.

Betsy

Avastin costs
Hi Betsy,
I was intrigued by your comments about the cost of Avastin. Would you mind if I asked you a couple of questions? First, how long ago did you receive Avastin? And, where, in general, do you live? If in the US, what section of the country? I don't know if that makes any difference or not, but I would like to talk with a few people if the price is that different. My husband's bill went from $8000 for Folfox to $22,000 when Avastin was added. Also, did you go to a regular oncologist or were you at a university or major hospital when you got your treatments? Thanks for the information that you already gave, it makes me a little less crabby at the Avastin producers, but now I want to know who is getting all of the extra money that our insurance is paying!

tanstaafl said:

3rd path
If I had to choose only between Golfig and Folfox + Avastin, I would look very hard at the specifics of Golfig including individual cases - real performances, costs, insurance payer's participation and tax deductibility (treatment is experimental in US, but the component drugs aren't). In fact, in my wife's case it would seem a no brainer, lab tests indicate she's resistant to Folfox and not Golfig.

My wife has no evidence of ongoing metastasis or residual macroscopic tumor masses (scan due next month). We have always fought her tumors (unknown masses or possible lung thingies) on the level of preventing spread with ultimate surgical removal, surgery hell or high water, rather than attempt direct chemical extermination, where failure is common. This allowed us to use far less noxious treatments, immunochemotherapy and nontoxic biochemistries for longer term, continuous treatment. She feels energized and never sick with chemo, slight wear on mental acuity and toughness.

At her 1st surgery, metastatic invasion through the mesentery headed into the peritoneum appeared to have been utterly wiped out by alternative biochemistry so we were pretty impressed with that approach and have expanded in that direction. However, the alternative neoadjuvant "only" shrunk the primary CC site and did not destroy misreported conglomerated para aortic lymph nodes (shrinkage unknown).

We use both immunochemotherapy from the Japanese research establishment with generic oral drugs, and more experimental/alternative nontoxic (nutrient based) biochemistries that have useful claims or lab results for us. For my wife's tumor cells, our very limited lab results indicated better cell kill with the chemo from the immunochemotherapy plus some nutrient molecules with known inhibitory properties, better than with 5FU+GEM+OXI.

tanstaafl,
I sent a private
tanstaafl,
I sent a private email to you--don't know for sure how you receive it but hopefully you are more knowledgeable about this site than I am!

Betsydoglover said:

My Avastin Cost
Hi - I did Avastin every 3 weeks for 2 years (this last go-round). Here's the billed charge:

Chemotherapy (nurse charge) - $460.00
Avastin (1160mg) - $8800.00

I have CIGNA insurance.

What they actually paid was:

Chemo (nurse charge) - $255.47
Avastin - $6686.90

I live in Maryland - suburban DC. I see a local oncologist and get my treatments at her office.

Hope this helps. That adds up to approximately $117,000 for a year of drug and infusion time (this doesn't include blood work). But it is certainly not $47000 per treatment!

At one point CIGNA asked my onc to order Avastin from them rather than from wherever she normally does. Turned about to be $200 more from Cigna than from what Cigna would pay my onc. Weird system! So they went back to my onc ordering it.

Thank you very much for all
Thank you very much for all of the information, Betsy. I truly wonder why there is such a difference in cost from one doctor to another. Seems like that should not be. Also, I thought I read that the company selling Avastin topped their cost at about $60,000 per year per patient. Is that not true?

laurettas said:

Thank you very much for all
Thank you very much for all of the information, Betsy. I truly wonder why there is such a difference in cost from one doctor to another. Seems like that should not be. Also, I thought I read that the company selling Avastin topped their cost at about $60,000 per year per patient. Is that not true?

Avastin cap
There is a sobering article from 2008 from the NY Times that states:

"In the United States, Genentech argues that it puts patients first, with free drugs for those who have no way to pay for them and donations to charities that can help with payments. It also capped the price for a year’s supply of Avastin at $55,000 (not counting markups by doctors and hospitals) for patients with incomes of less than $100,000 a year."

http://www.nytimes.com/2008/07/06/health/06avastin.html

However, I am pretty sure this is for people who are going entirely out-of-pocket. They do have some other programs for co-pays and the like that can be found on Genentech's site from the link in my post above.

It's an ugly game regardless if you have good insurance or not. Even with a great plan, if you have a lifetime cap on coverage ..... watch out.

Betsydoglover said:

Brownbagging Chemo Drugs
The billed amount has almost nothing to do with the negotiated payment. That said I had Avastin only for 2 years and the billed amount (including nurses etc) was around $9000 every 3 weeks. What was negotiated and paid was less.

Something is way wrong with $47000 per treatment. You really need to call the insurance company and see what is going on. My company is also self insured - that doesn't mean the billed rate has anything to do with the actual payment. But, I have NEVER heard of anything like $47,000 - can't blame Avastin or anything else for that.

Betsy

Agree - billed amount does not mean amount paid to
insurance company.

However, one disadvantage to self-insured companies is that they need the funds to pay all their claims. While they will use a major insurer to manage and negotiate for them (find in-network providers, et al) when push comes to shove, the company, not the insurer, pays out the claims from its own pot. When the money runs out, the insurance runs dry - for everyone in the company (we've seen this happen.)

As a note, for anyone whose company is self-insured, be sure to get your claims in as quickly as possible, because when the pot runs dry, they stop paying. It doesn't matter that your claim was dated 3 months ago, and someone else had a claim paid for an event 2 weeks ago. It's strictly a matter of if there is money to pay your claim when you submit it.