Crazy high cost of Doxil & Nuelasta !!

lindaprocopio
lindaprocopio Member Posts: 1,980
edited March 2014 in Ovarian Cancer #1
My hospital billed my insurance company $30,800 for a single round of Doxil; and $17,000 for the Nuelasta shot I got the next day. My insurance negotiated that down and paid $24,000 for that single Doxil infusion, and $14,000 for the Nuelasta shot. So, even with the negotiated discount, my insurance is paying my oncology center $38,000 every 28 days for my treatments!! And that doesn't include anything else I might need; my CT/PET scans are billed at $22,000@!

I have very expensive private insurance, (with a $7,500 deductible that I pay every January with my first chemo infusion of the year) as I own my own business, and last year, even with NO surgeries, my insurance paid out $330,000 for my cancer treatments.

When I told my chemo oncologist what we were being billed he was SHOCKED. (He guessed $18,000 for the Doxil before I told him $30,800.) He said that they routinely mark up all pharmamcy costs 300%. Apparently, they try to get whatever the market will bear. Those with private insurance pay sooooooo much more than those on other group insurances. I am so very grateful that I have such good insurance and am able to pay the monthly premiums of over $1,000@. God help the uninsured!

I was just wondering if anyone else knows what they are billed for chemo and Nuelasta and CT/PET scans. I've never seen ANY discussion on TV by our legislators about how hospitals mark up their costs; politicians always seem to want to make the insurance companies out as the villans. We may not need the healthcare reform we GOT, but we sure as hell need healthcare reform in this country.

Comments

  • nancy591
    nancy591 Member Posts: 1,027 Member
    wow
    I looked up how much my hosptial billed when I was on Doxil. $6,043 for 70.000mg and $4,316 for 50.000mg.

    Neulasta $764 for them to inject. Now I self inject and have a copay of about $20. I believe the bill rate is a lot higher for me to self inject.

    Gemzar cost $1970 for 1400.000mg
    Carboplat cost $123 for 522.000mg

    The IV infusion cost $391 per hour

    PET/CT skull to thigh $3,420
    contrast $750

    I wonder why there is such a stark contrast in pricing!
  • Mum2bellaandwilliam
    Mum2bellaandwilliam Member Posts: 412
    nancy591 said:

    wow
    I looked up how much my hosptial billed when I was on Doxil. $6,043 for 70.000mg and $4,316 for 50.000mg.

    Neulasta $764 for them to inject. Now I self inject and have a copay of about $20. I believe the bill rate is a lot higher for me to self inject.

    Gemzar cost $1970 for 1400.000mg
    Carboplat cost $123 for 522.000mg

    The IV infusion cost $391 per hour

    PET/CT skull to thigh $3,420
    contrast $750

    I wonder why there is such a stark contrast in pricing!

    Thank god for the NHS!
    Gosh , who would think it!! I new the price of chemotherapy drugs was very high but that is outrageous!!! Nancys' prices are the kind of figure I had in my head!!! Legalised thieves?!
  • kayandok
    kayandok Member Posts: 1,202 Member
    I find this amazing!
    How can they get by with this? Japan is socialized and I pay a flat 30% of everything. So, going by that, my chemo cost is very close to the ones that Nancy has listed.
    I guess those who are uninsured just don't live as long in the US. And as someone eventually headed back, not qualifiying for any insurance except Medicade, that is a scary thought.
    k
  • Mum2bellaandwilliam
    Mum2bellaandwilliam Member Posts: 412
    kayandok said:

    I find this amazing!
    How can they get by with this? Japan is socialized and I pay a flat 30% of everything. So, going by that, my chemo cost is very close to the ones that Nancy has listed.
    I guess those who are uninsured just don't live as long in the US. And as someone eventually headed back, not qualifiying for any insurance except Medicade, that is a scary thought.
    k

    Uk price = 0.00 once again
    Uk price = 0.00 once again thank god for our free health service, I know we pay for it through taxes etc, but at least everyone gets the same treatment regardless of their financial status. We also asked if you would get a better treatments plan going private and the answer was no , exactly the same! Good old NHS.
  • Mum2bellaandwilliam
    Mum2bellaandwilliam Member Posts: 412
    kayandok said:

    I find this amazing!
    How can they get by with this? Japan is socialized and I pay a flat 30% of everything. So, going by that, my chemo cost is very close to the ones that Nancy has listed.
    I guess those who are uninsured just don't live as long in the US. And as someone eventually headed back, not qualifiying for any insurance except Medicade, that is a scary thought.
    k

    Uk price = 0.00 once again
    Uk price = 0.00 once again thank god for our free health service, I know we pay for it through taxes etc, but at least everyone gets the same treatment regardless of their financial status. We also asked if you would get a better treatments plan going private and the answer was no , exactly the same! Good old NHS.
  • lindaprocopio
    lindaprocopio Member Posts: 1,980

    Uk price = 0.00 once again
    Uk price = 0.00 once again thank god for our free health service, I know we pay for it through taxes etc, but at least everyone gets the same treatment regardless of their financial status. We also asked if you would get a better treatments plan going private and the answer was no , exactly the same! Good old NHS.

    And what's worse, I don't think it's even WORKING for me!
    Just got my CA125 from yesterday's 'between chemos' nadir blood work. My CA125 climbed to an all-time high of 190.4 following 2 rounds of Doxil, up from 155 2 weeks ago.

    ARGH! I'm afraid I'm going to have some bad news for my family right before the holidays. My CA125 climbed to 134 while I was trying to get into that Clinical Trial. Then my first round of Doxil took it up to 172 at my nadir labs, and 155 at the labs I had right before my 2nd Doxil infusion. Yesterday I had my nadir labs drawn to see where I am after 2 rounds of Doxil. My CA125 shot back up to a new all-time high of 190.4. My oncologist told me not to read too much into it, but I can't help but be concerned that Doxil simply isn't working for me. I'd love for him to add carboplatin to the Doxil but he knows my platelets and red counts will tank if we do. Maybe I can talk him into adding Avastin, although he is not an Avastin fan.

    We're going to do 1 more round of Doxil on November 11th and then do a new CT/PET scan. I am worried that I will have bad news for my family right before the holidays; they will be devastated if I have disease progression. I feel so GOOD on Doxil; I was hoping to be able to stay on it until it shrunk these lymph nodes down to nothing. If the CT/PET shows that I have disease progression, I think we'll try targeted radiation next.

    Bummer. :(
  • kayandok
    kayandok Member Posts: 1,202 Member

    And what's worse, I don't think it's even WORKING for me!
    Just got my CA125 from yesterday's 'between chemos' nadir blood work. My CA125 climbed to an all-time high of 190.4 following 2 rounds of Doxil, up from 155 2 weeks ago.

    ARGH! I'm afraid I'm going to have some bad news for my family right before the holidays. My CA125 climbed to 134 while I was trying to get into that Clinical Trial. Then my first round of Doxil took it up to 172 at my nadir labs, and 155 at the labs I had right before my 2nd Doxil infusion. Yesterday I had my nadir labs drawn to see where I am after 2 rounds of Doxil. My CA125 shot back up to a new all-time high of 190.4. My oncologist told me not to read too much into it, but I can't help but be concerned that Doxil simply isn't working for me. I'd love for him to add carboplatin to the Doxil but he knows my platelets and red counts will tank if we do. Maybe I can talk him into adding Avastin, although he is not an Avastin fan.

    We're going to do 1 more round of Doxil on November 11th and then do a new CT/PET scan. I am worried that I will have bad news for my family right before the holidays; they will be devastated if I have disease progression. I feel so GOOD on Doxil; I was hoping to be able to stay on it until it shrunk these lymph nodes down to nothing. If the CT/PET shows that I have disease progression, I think we'll try targeted radiation next.

    Bummer. :(

    Oh Linda,
    I'm so sorry! They do say that on doxil, your number can climb before it goes down, but that has to be discouraging. Keeping you in my prayers today,
    hugs,
    kathleen❧
  • Tina Brown
    Tina Brown Member Posts: 1,036 Member
    Hello Linda
    I am so flabbergasted to read your post. As you know I'm from the UK and our health service is very different to yours. We pay a contribution of our monthly salaries into the NHS (National Health Service) about 12%. For that we get all of our cancer treatment (diagnosis, scans, surgery, chemotherapathy, follow up check ups) absolutely FREE. I knew the people in the states had to pay through their insurance but I never imagined it was so high. I thought each infusion of chemo was on average £1,000 - £2,000 ($2,000 - $4,000) Also, as a cancer patient we are able to receive all of our prescriptions free (they cost £7.20/$13.00 to people otherwise for each item) so any meds I need, even if it not cancer related, I get for free.

    So I agree with you - God help the uninsured!!!!

    On reflection medicine in the states does seem a little more advanced than here in the UK as you are able to have certain drugs we can't get over here like Avastin (unless you pay) Our controlling body who decided what drugs we can use won't sanction avastin because it is too expensive. However many top oncologists are currently fighting that decision.

    I bet you are so glad you have your insurance, love Tina xx
  • Tina Brown
    Tina Brown Member Posts: 1,036 Member

    And what's worse, I don't think it's even WORKING for me!
    Just got my CA125 from yesterday's 'between chemos' nadir blood work. My CA125 climbed to an all-time high of 190.4 following 2 rounds of Doxil, up from 155 2 weeks ago.

    ARGH! I'm afraid I'm going to have some bad news for my family right before the holidays. My CA125 climbed to 134 while I was trying to get into that Clinical Trial. Then my first round of Doxil took it up to 172 at my nadir labs, and 155 at the labs I had right before my 2nd Doxil infusion. Yesterday I had my nadir labs drawn to see where I am after 2 rounds of Doxil. My CA125 shot back up to a new all-time high of 190.4. My oncologist told me not to read too much into it, but I can't help but be concerned that Doxil simply isn't working for me. I'd love for him to add carboplatin to the Doxil but he knows my platelets and red counts will tank if we do. Maybe I can talk him into adding Avastin, although he is not an Avastin fan.

    We're going to do 1 more round of Doxil on November 11th and then do a new CT/PET scan. I am worried that I will have bad news for my family right before the holidays; they will be devastated if I have disease progression. I feel so GOOD on Doxil; I was hoping to be able to stay on it until it shrunk these lymph nodes down to nothing. If the CT/PET shows that I have disease progression, I think we'll try targeted radiation next.

    Bummer. :(

    Just read your second post
    Just read your second post. I am so sorry to read about the disappointing blood results. Not sure what nadir labs tests mean? I am just about to start Caelyx (Doxil in the states) so I will be prepared for my numbers to go up before they hopefully come down.

    I do hope the numbers come down next appointment, keeping my fingers crossed for you.

    Tina xx
  • clamryn
    clamryn Member Posts: 508
    PET/CT Scan
    Hi Linda, I just checked my last bill for my PET/CT Scan and the cost was $5,950. Insurance got it down to $3750. I don't understand how they can charge such an outrageous price for some and not others. Unbelievable.

    When I had my reoccurence in 2008, I had completed all of my Taxol treatments and then at the end of the year my company laid me off. Here I was 60 years old, divorced and medical problems. I knew I would be one of the ones to go due to being the highest paid in the department and then I was starting to cost them money with my medical bills. I was a liability to them. My biggest fear was losing my health coverage. Naturally, I had to take the COBRA (which is expensive but it was good coverage). Due to having cancer and also interstitial lung disase, I filed for disability and got it. The COBRA will be extended for me for another 11 months due to going on disability. That will take me to my eligibility date for Medicare. I have to be on disability for 24 months befoe Medicare will kick in. I am hoping that when I do go on Medicare that I won't have any problems with getting what I need. Kind of scary.

    I went on the Doxil in 2010 and completed 8 treatments of that. My CA125 did go down during treatments and the Doxil did kill 3 of my spots but one still remains (which in in the liver). Since I have been off the Doxil for 2 months now, my CA125 has went up slowing 2 to 3 points at a time. Doctor says not to worry. (Yeah right). I am currently on the Metformin and will find out if it is working when I will get another PET/Scan in December. Linda I will be praying that the Doxil works for you. I thought I read somewhere that Doxil is slow working.

    I think we need healthcare reform in this country too. Surely they can come up with something.

    Hugs to you..... Linda
  • nancy591
    nancy591 Member Posts: 1,027 Member

    And what's worse, I don't think it's even WORKING for me!
    Just got my CA125 from yesterday's 'between chemos' nadir blood work. My CA125 climbed to an all-time high of 190.4 following 2 rounds of Doxil, up from 155 2 weeks ago.

    ARGH! I'm afraid I'm going to have some bad news for my family right before the holidays. My CA125 climbed to 134 while I was trying to get into that Clinical Trial. Then my first round of Doxil took it up to 172 at my nadir labs, and 155 at the labs I had right before my 2nd Doxil infusion. Yesterday I had my nadir labs drawn to see where I am after 2 rounds of Doxil. My CA125 shot back up to a new all-time high of 190.4. My oncologist told me not to read too much into it, but I can't help but be concerned that Doxil simply isn't working for me. I'd love for him to add carboplatin to the Doxil but he knows my platelets and red counts will tank if we do. Maybe I can talk him into adding Avastin, although he is not an Avastin fan.

    We're going to do 1 more round of Doxil on November 11th and then do a new CT/PET scan. I am worried that I will have bad news for my family right before the holidays; they will be devastated if I have disease progression. I feel so GOOD on Doxil; I was hoping to be able to stay on it until it shrunk these lymph nodes down to nothing. If the CT/PET shows that I have disease progression, I think we'll try targeted radiation next.

    Bummer. :(

    Doxil
    My ca125 did rise, fall and rise while I was on Doxil. My numbers were still within normal range at the time but I did have a confirmed recurrence prior to starting. We did 5 infusions of Doxil before moving on. 3 infusions, scan, 2 more infusions (ca125 jumped another 13 points), scan. My progression was not too bad but progression none the less.

    I read your post last night as I was leaving for a Halloween party for the kids. It really scared me. Scared me for you, for myself, as well as for every woman on this board. As we discussed in another post, my ca125 is at an all time high since my recurrence last year. I was having little jumps up and down for the past year. Now I am having BIG jumps. My ca125 is 124.

    Hang tight Linda.

    XOXOXO
  • Mwee
    Mwee Member Posts: 1,338
    I'm shocked
    WOW... I had 4 doxil treatments that were infused at my Drs. office and my insurance was charged about 3500.00 per infusion including the price for the service, flushing, etc.. The payout to my Dr. was a few hundred less than that. How can these prices differ so much. I have nuelasta shot once a month and pay a $16.00 co-pay to Medco. That mark up is way more than 300%.
    Maria
  • Hissy_Fitz
    Hissy_Fitz Member Posts: 1,834
    Mwee said:

    I'm shocked
    WOW... I had 4 doxil treatments that were infused at my Drs. office and my insurance was charged about 3500.00 per infusion including the price for the service, flushing, etc.. The payout to my Dr. was a few hundred less than that. How can these prices differ so much. I have nuelasta shot once a month and pay a $16.00 co-pay to Medco. That mark up is way more than 300%.
    Maria

    I have not received Doxil,
    I have not received Doxil, or Nuelasta, but my Taxol maintenance is almost $50,000 for the one year course of 12 infusions. That's before the negotiated discount. Each infusion is billed at $4100; the Medicare allowance is $453, of which they pay $360. My secondary insurance pays the balance ($93), so my part is zero, provided I have met the annual deductible and out-of-pocket.

    Medicare is able to negotiate huge discounts, simply because they are the WalMart of health insurance. They have the most customers, so they demand, and get, the biggest discounts. People who have private insurance get much smaller discounts, and those who are uninsured get NO discounts whatsoever - they are billed full price, even though they are much less likely to be in a position to pay than even the smallest insurance company. Crazy logic, if you ask me.

    We have a friend with prostate cancer who takes monthly Nuelasta and has Secure Horizons insurance (Medicare alternative). His co-pay is $1700 per shot, or 20% of what his insurance is billed ($8500).

    I read an article last week about oncologists who do their own infusions, and how they bill for their services. Most of them are fee for service doctors, but places like Kaiser have developed a plan whereby the doctor gets a set fee for the entire course of treatment, which varies with the type and stage of cancer being treated. The doctor can prescribe and administer whatever treatment he/she so desires, but the pay-out will be the same. It's unlikely, given that scenario, that I would have been offered a year of Taxol maintenance, nor would Avastin be in my future. Insurance companies are really pushing for this type of arrangement, and a couple of them have started pilot programs with some forms of cancer.

    I have cut and pasted a very eye-opening article below....


    WASHINGTON -- UnitedHealthcare, one of the nation's largest health insurers, said Wednesday that it is testing, at a Fort Worth clinic and elsewhere, a new way to pay for some cancer treatments, aiming to identify the best medicines and limit doctors' profits from dispensing in-office chemotherapy drugs.

    Insurers, employers and the government are looking to streamline costs by paying doctors and hospitals lump sums for an entire course of care rather than fees for each service.

    Payment for chemotherapy has been particularly controversial because some doctors, including oncologists, buy drugs at wholesale prices, dispense them by injection or infusion to patients in their offices and charge insurers higher, retail prices.

    A government report found that Medicare, for example, reimbursed doctors at least $532 million more in 2000 than the doctors had paid to buy the medicines. In 2005, Medicare changed the way it pays for in-office drugs, ratcheting down payments to average sales prices plus 6 percent. A few private insurers followed suit.

    UnitedHealthcare takes a different approach. Its program, under way with five oncology practices in five states, pays physicians lump sums for each patient's course of chemotherapy for breast, lung or colon cancer. The payment is based on regimens that the doctors draw up themselves, plus case management fees.

    It's the first large foray into payment bundling for chemotherapy by a private insurer, although other insurers are testing the approach for hip and knee replacements and Medicare will launch a program next year that combines drugs with dialysis services. The health overhaul law also calls for such payments.

    The insurer aims to "separate oncologists' income from their drug selection" and "start searching for the best practices and move to them," said Dr. Lee Newcomer, UnitedHealthcare's senior vice president for oncology.

    UnitedHealthcare is running the program at practices with 18 to 35 oncologists in Fort Worth; Dayton, Ohio; Kansas City, Mo.; Marietta, Ga.; and Memphis.

    If successful, it will expand to other practices and possibly other conditions, such as rheumatoid arthritis, for which expensive drugs are dispensed in doctors' offices.
  • Pam Bush
    Pam Bush Member Posts: 3
    nancy591 said:

    Doxil
    My ca125 did rise, fall and rise while I was on Doxil. My numbers were still within normal range at the time but I did have a confirmed recurrence prior to starting. We did 5 infusions of Doxil before moving on. 3 infusions, scan, 2 more infusions (ca125 jumped another 13 points), scan. My progression was not too bad but progression none the less.

    I read your post last night as I was leaving for a Halloween party for the kids. It really scared me. Scared me for you, for myself, as well as for every woman on this board. As we discussed in another post, my ca125 is at an all time high since my recurrence last year. I was having little jumps up and down for the past year. Now I am having BIG jumps. My ca125 is 124.

    Hang tight Linda.

    XOXOXO

    Doxil
    I just started Doxil in July and was just told that there is a nation-wide shortage and will have to have a different drug this Friday. Has anyone run into this. Pam
  • Tethys41
    Tethys41 Member Posts: 1,376 Member
    Pam Bush said:

    Doxil
    I just started Doxil in July and was just told that there is a nation-wide shortage and will have to have a different drug this Friday. Has anyone run into this. Pam

    Doxil Shortage
    Pam,
    I did see a posting on another board saying this was going to be an issue. I didn't know whether it was just fear mongering or had some validity to it. Evidently, it has some validity.
  • zinaida
    zinaida Member Posts: 221
    Tethys41 said:

    Doxil Shortage
    Pam,
    I did see a posting on another board saying this was going to be an issue. I didn't know whether it was just fear mongering or had some validity to it. Evidently, it has some validity.

    I was on Doxil every 4 weeks
    I was on Doxil every 4 weeks from January. My doctor call me and told about Doxil shortage national wide and did make appointment with me on August 9, to discuse about new chemo for me.
  • Tethys41
    Tethys41 Member Posts: 1,376 Member
    Pam Bush said:

    Doxil
    I just started Doxil in July and was just told that there is a nation-wide shortage and will have to have a different drug this Friday. Has anyone run into this. Pam

    Shortage Information
    I found this link to information related to the shortage:

    http://www.doxil.com/sites/default/files/DOXIL_DHCP_letter_July2011.pdf