Left high and dry by BCBS regarding Xeloda
Mary
Comments
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BCBS
Hi Mary
I used to take Xeloda a few years ago when my onc wanted me to try it. The cancer center had a pharmacy there and my BCBS charged me $150 per bottle, though the total cost was $2000. I paid for them there and took them home to take.
Not sure if BCBS has changed their policy on this - perhaps it is with your specific insurance plan or not.
What you could do as a workaround is have them do 5-fu by pump in the clinic and then the insurance would have to cover you minus the portion you are responsible for up to the maxium out of pocket allowed.
Xeloda is the pill form of 5-fu, so going with the pump still gets you the drug. Something to consider:)
-Craig0 -
BCBSSundanceh said:BCBS
Hi Mary
I used to take Xeloda a few years ago when my onc wanted me to try it. The cancer center had a pharmacy there and my BCBS charged me $150 per bottle, though the total cost was $2000. I paid for them there and took them home to take.
Not sure if BCBS has changed their policy on this - perhaps it is with your specific insurance plan or not.
What you could do as a workaround is have them do 5-fu by pump in the clinic and then the insurance would have to cover you minus the portion you are responsible for up to the maxium out of pocket allowed.
Xeloda is the pill form of 5-fu, so going with the pump still gets you the drug. Something to consider:)
-Craig
Hi Craig, I have no prescription drug coverage, although I would have been covered 100% if I wanted to undergo the standard of getting a port and be infused at the cancer center. I didn't want the port. I wanted to be able to take the Xeloda at home and have once every three week infusions of Oxaliplatin (which is covered 100%). BCBS does not recognize that Xeloda is the 5FU part of the chemo. It's crazy. Of course, it's always down to the bottom line with these issues. I'm so stressed out and I haven't even started treatment yet! Thanks for getting back to me.
Mary
PS: When I bought into my BCBS policy a couple of years ago, I had not had a sick day in my life, not one! I went from that to colon cancer diagnosis in about a week. I only wanted something to cover me if I fell over and broke a hip or something, ya know. Something to cover me until Medicare kicked in. I'm 64 and will be 65 in April. So, I took out the policy with economics in mind....so, here I am..0 -
tourism
We engage in medical tourism and shopping for uncovered expenses. Drug options are larger without the FDA protecting their phavorite patrons, and costs can be much, much lower. I am talking in person or friends/family purchases, not the internet scams.0 -
Mary,pascall5 said:BCBS
Hi Craig, I have no prescription drug coverage, although I would have been covered 100% if I wanted to undergo the standard of getting a port and be infused at the cancer center. I didn't want the port. I wanted to be able to take the Xeloda at home and have once every three week infusions of Oxaliplatin (which is covered 100%). BCBS does not recognize that Xeloda is the 5FU part of the chemo. It's crazy. Of course, it's always down to the bottom line with these issues. I'm so stressed out and I haven't even started treatment yet! Thanks for getting back to me.
Mary
PS: When I bought into my BCBS policy a couple of years ago, I had not had a sick day in my life, not one! I went from that to colon cancer diagnosis in about a week. I only wanted something to cover me if I fell over and broke a hip or something, ya know. Something to cover me until Medicare kicked in. I'm 64 and will be 65 in April. So, I took out the policy with economics in mind....so, here I am..
Reconsider the port, many of us have them, and frankly it is a real convenience! It saves the veins in your arms, and can be used for blood draws, hospital IV drips, getting fluids in-between treatments etc, etc.... It causes no pain (once the healing is done) and it does not get in the way of daily living.
As far as I know, all US insurance companies pay for the infusion as medical, and any pill you can take at home (ie: Xeloda) as pharmacy.
Even when you switch to Medicare you will probably find the Xeloda is not covered under part B, and you will have a significant out of pocket expense to take it.
Just saying that your Oncologist was probably steering you to the best option.0 -
xelodaBuckwirth said:Mary,
Reconsider the port, many of us have them, and frankly it is a real convenience! It saves the veins in your arms, and can be used for blood draws, hospital IV drips, getting fluids in-between treatments etc, etc.... It causes no pain (once the healing is done) and it does not get in the way of daily living.
As far as I know, all US insurance companies pay for the infusion as medical, and any pill you can take at home (ie: Xeloda) as pharmacy.
Even when you switch to Medicare you will probably find the Xeloda is not covered under part B, and you will have a significant out of pocket expense to take it.
Just saying that your Oncologist was probably steering you to the best option.
Yep, your right Buckwirth, if I get a port and have FOLFOX it will be covered. I just wanted less trips to the clinic and REALLY have heard nightmares about the port. I'm so needle-phobic that that settled it for me. How long after you had your port placed did you start chemo?
Mary0 -
Portpascall5 said:xeloda
Yep, your right Buckwirth, if I get a port and have FOLFOX it will be covered. I just wanted less trips to the clinic and REALLY have heard nightmares about the port. I'm so needle-phobic that that settled it for me. How long after you had your port placed did you start chemo?
Mary
Sometimes the port is accessed the next day so they usually don't have to wait much time between insertion and treatment.
Kim0 -
PortAnnabelle41415 said:Port
Sometimes the port is accessed the next day so they usually don't have to wait much time between insertion and treatment.
Kim
Thanks Kim.0 -
PortAnnabelle41415 said:Port
Sometimes the port is accessed the next day so they usually don't have to wait much time between insertion and treatment.
Kim
Thanks Kim.0 -
I have hadpascall5 said:xeloda
Yep, your right Buckwirth, if I get a port and have FOLFOX it will be covered. I just wanted less trips to the clinic and REALLY have heard nightmares about the port. I'm so needle-phobic that that settled it for me. How long after you had your port placed did you start chemo?
Mary
the port for about 18 months. When accessed you do not see the needle going in, and for the most part it is painless.
Given that there are usually other treatments besides the Xeloda (5FU with infusion), it is a much better option than the arm.0 -
PortAnnabelle41415 said:Port
Sometimes the port is accessed the next day so they usually don't have to wait much time between insertion and treatment.
Kim
Did you ever use the EMLA numbing cream for the sticks?
Heard this makes it so much better. (OK I own it, I'm petrified of needles).
Mary0 -
All has changed on chemo policy in last week
Some of you may not be aware that the recommendations by the American Hospital Association and the FDA last week advised that new chemo patients not already on Folfox/5 FU not be started on it due to national shortages of FU and uncertainty of supplies until later in the year. Those already on it can still get it if available supplies are in, according to the announcement.
That means those of us who were scheduled to start the treatment by infusion in the last few days at major cancer centers following the recommendation were not able to get the standard chemo treatment of Folfox because we were new. Doctors are having to change us to other regimens -- for Stage 3-4 crc it is most likely oxilapalatin infusion plus oral Xeloda that is being substituted for Folfox.
First, this shifts the burden of the costs to the patient because oral Xeloda is treated as a pharmacy plan cost while infusions are covered under major medical. I also would have had my treatment covered 100 percent under major medical if I had been allowed to proceed with the planned 5FU by infusion.
This morning I did find out my Xeloda oral is not covered by Blue Cross Blue Shield because it is not in their formulary (and I, unlike the original poster, even have pharmacy coverage). My prescription is sitting at a pharmacy as of today and it will cost me $1700 out of pocket for the first 40 pills of treatment. Today I have applied for two pharmacy financial assistance programs and hope to get approved for one of them this week. One is through the manufacturer of Xeloda, Genentech Access program for patients. The other is through another pharmaceuticals company in partnership with my cancer center.
Meanwhile, I wait days without any treatment due to the drug shortage announcement last week and its policy repercussions.
The Genentech people said they may be able to process my application within the week; haven't heard back from the second company.
If you haven't seen the New York Times article about all this, which was published on Friday, see link below. It reports that the FDA admits some suppliers are buying up all available supplies of cancer drugs and hoping to create shortages in order to sell their backstock at prices 10 times the value for big profit.
http://www.nytimes.com/2011/08/20/health/policy/20drug.html?_r=1&hp
K10 -
ACK!!!pascall5 said:BCBS
Hi Craig, I have no prescription drug coverage, although I would have been covered 100% if I wanted to undergo the standard of getting a port and be infused at the cancer center. I didn't want the port. I wanted to be able to take the Xeloda at home and have once every three week infusions of Oxaliplatin (which is covered 100%). BCBS does not recognize that Xeloda is the 5FU part of the chemo. It's crazy. Of course, it's always down to the bottom line with these issues. I'm so stressed out and I haven't even started treatment yet! Thanks for getting back to me.
Mary
PS: When I bought into my BCBS policy a couple of years ago, I had not had a sick day in my life, not one! I went from that to colon cancer diagnosis in about a week. I only wanted something to cover me if I fell over and broke a hip or something, ya know. Something to cover me until Medicare kicked in. I'm 64 and will be 65 in April. So, I took out the policy with economics in mind....so, here I am..
If your getting the oxi, get the PORT, I did it without a port 6 times, my veins collapsed, it was painful and would often have to change arms to finish the infusion because of the intense burning. I then begged for the port, wheh, what a difference!!!
I tell ya, you'll love the port. My regime, was OXI, Xeloda and Avastin.
Winter Marie0 -
I was petrified of the port.
I was petrified of the port. But had to have it and honestly it wasn't bad at all. I had the port put in on a tuesday and they used it for the first time on Thursday. It did make things easier, and I can say the first time they accessed it, it hurt a little, but after time it did not. I suppose the skin was used to it by then.0 -
Creampascall5 said:Port
Did you ever use the EMLA numbing cream for the sticks?
Heard this makes it so much better. (OK I own it, I'm petrified of needles).
Mary
There was some cream (Lidocaine) that would be put over the port and then would tape a pice of gauze over it so the lidocaine stays on until they access the port. I'd put it on at least an hour before my appointment. It numbs the whole area and you never feel anything and actually the thing they access it with doesn't even look like a needle. You would be fine with it because I'm not one for needles either.
Kim0 -
BCBSkhl8 said:I was petrified of the port.
I was petrified of the port. But had to have it and honestly it wasn't bad at all. I had the port put in on a tuesday and they used it for the first time on Thursday. It did make things easier, and I can say the first time they accessed it, it hurt a little, but after time it did not. I suppose the skin was used to it by then.
BCBS of Oregon is my health insurance. They have covered, with out hesitation, my oxaliplatin and Xeloda. Here is a link to their formulary: http://www.regencerx.com/learn/covered/alpha/index.html#top
A box of goodies came with my first prescription. It Included a DVD, literature, and a fanny pack that was stamped "Xeloda now covered by part B Medicare" I figure what is stamped on my fanny pack must be true:)
I can find the link for this if you desire. I know it is based on the fact that this is a substitute straight across for 5FU and therefore covered by part B rather than part D.
I had the additional fortune of turning 65 in June. That made me eligible for Medicare and provided double coverage for everything. While confusing, I am most grateful that I have coverage. I grieve for those who are not as fortunate. It is well documented that lack of financial resources substantially impacts the prognosis.
Norm0 -
Part BKimo Sabe said:BCBS
BCBS of Oregon is my health insurance. They have covered, with out hesitation, my oxaliplatin and Xeloda. Here is a link to their formulary: http://www.regencerx.com/learn/covered/alpha/index.html#top
A box of goodies came with my first prescription. It Included a DVD, literature, and a fanny pack that was stamped "Xeloda now covered by part B Medicare" I figure what is stamped on my fanny pack must be true:)
I can find the link for this if you desire. I know it is based on the fact that this is a substitute straight across for 5FU and therefore covered by part B rather than part D.
I had the additional fortune of turning 65 in June. That made me eligible for Medicare and provided double coverage for everything. While confusing, I am most grateful that I have coverage. I grieve for those who are not as fortunate. It is well documented that lack of financial resources substantially impacts the prognosis.
Norm
Yes it is covered by Part B as "Part B, DME", my co-pay is $431.97. Although I did discover the Xeloda was costing only (ha ha, "only") 1900.00 instead of 2800.00 like I mentioned earlier. The below is from my "MyMedicare.gov" page, showing the Part B, DME cost, their payment amount, and then lastly my co-pay amount, if it was under Part D it would have been so much cheaper for me. Oh well.
Winter Marie
PHA RMACY INC
CHICAGO, IL 606909999 DME
Start:
02/21/11
End:
02/21/11
$1,933.32 $1,932.98 $1,501.01 $56.72 $431.970 -
Xeoldaherdizziness said:Part B
Yes it is covered by Part B as "Part B, DME", my co-pay is $431.97. Although I did discover the Xeloda was costing only (ha ha, "only") 1900.00 instead of 2800.00 like I mentioned earlier. The below is from my "MyMedicare.gov" page, showing the Part B, DME cost, their payment amount, and then lastly my co-pay amount, if it was under Part D it would have been so much cheaper for me. Oh well.
Winter Marie
PHA RMACY INC
CHICAGO, IL 606909999 DME
Start:
02/21/11
End:
02/21/11
$1,933.32 $1,932.98 $1,501.01 $56.72 $431.97
Thanks to everyone for your replies. My case worker called me and is working on getting my Xeloda for me! I'm so grateful! Extraordinary things can happen when you pray.0 -
This is one of the big reasons I like our clients to get Rx
coverage - oral chemo drugs are considered as part of prescriptions drugs, while IV chemo is a procedure.
As for the port - it makes life so much easier! Minor surgical placement, and then the lidocaine/Emla cream - you don't feel the needles.
Heck, I had a belly port for a while for chemo directly into my abdomen. With Emla, I didn't feel those needles go in (and there is something particularly yucky about needles into the belly.)
Hopefully, you can get an exception for your Xeloda, but if not, ask about the 5FU IV.0 -
Any progress?abrub said:This is one of the big reasons I like our clients to get Rx
coverage - oral chemo drugs are considered as part of prescriptions drugs, while IV chemo is a procedure.
As for the port - it makes life so much easier! Minor surgical placement, and then the lidocaine/Emla cream - you don't feel the needles.
Heck, I had a belly port for a while for chemo directly into my abdomen. With Emla, I didn't feel those needles go in (and there is something particularly yucky about needles into the belly.)
Hopefully, you can get an exception for your Xeloda, but if not, ask about the 5FU IV.
How is it going? Had success? I would be interested in an update. Please let us know if you remain unsuccessful. I have a couple other ideas that I will check out tomorrow. It would help to know what state you are in. My BCBS copay is $50 for 2 weeks. This isn't right.
Norm0
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