Starting Tx Questions

My husband saw his GI doc today and got the results of his liver biopsy. The doctor said his liver inflammation was a Stage 2 and the liver scarring is Stage 3.  No cirrhosis yet.  Hopefully with tx he won't have cirrhosis.  He will start tx in a few weeks. The doctor told him he may be sick for a while in the beginning on the tx meds.  He told my husband he may not have to be treated for a full 48 weeks.  He said it would depend on his blood cell counts during tx.  He also told my husband the meds are very expensive and come from a specialty pharmacy.  We will be waiting for them to call us and tell us how much our co-pay will be with our medical insurance.  If the cost is totally out of our reach we will try and get financial aid.  He and I both are retired so our income is not as high as when we both worked.
How much is your co-pay???  We have BCBS HealthSelect.  I will be very anxious until I know how much it will be.

Linda

[Bill1954]

Hi Linda,

It will depend on your individual policy. The combined cost for meds (interferon/ribavirin) will probably be around USD$ 2500/month to the insurance company; this will vary again depending on their contract purchases.

Some plans cover this under an Rx plan, and charge $20.00 -50.00/month. Others charge copays up to 33% for specialty injectables; in this case, you’re copay could be $825.00/month.

If you’re faced with unreasonable costs, I’d encourage you to call the manufacturers and inquire about their patient assistance programs. I used them for my second treatment, and they’re very helpful and professional. These programs are income rather than asset based; they don’t care if you have money in the bank, how many homes you owe, etc. They’ll probably review last year’s federal 1040 form, and possibly a bank statement or two. Sometimes they don’t even go that far. Here are the numbers again if you need them:

Pegassist (Roche Pegasys system): 1-877-734-2797

Commitment to Care (Schering- Plough PEG-Intron system): 1-800-521-7157

As he gets into treatment, it may become necessary to include ‘rescue’ drugs as well if his red or white cells require boosting. These drugs are very pricey as well, and there are patient assistance plans for these too.

I imagine you could call the phone number on your insurance card, and ask them to quote your monthly cost; there are a couple of drugs, so be sure to ask your doctor which brand (Pegasys/Copegus or Pegintron/Rebetol), and also dosing prior to calling. There are generics available for the ribavirin component, if that helps with cost.

Best of luck to your husband, and let us know how things proceed—

Bill

[kat128]

Hi I am new to the board. I am on my third week of treatment- and my copay is currently $15 for Ribavirin and $30 for the injections.  

Off topic- but this forum is very helpful!

[toaofpooh]

Wow, I’m so Jealous, my co pay is $525 per month. Fortunately, I have a $1500 maximum out of pocket annual limit. My insurance company failed to tell me that my policy had an out of pocket ceiling; I had to research it myself before deciding to undergo treatment. I guess they were hoping that I would opt not to treat if I thought I had to pay $10,000 out of pocket. Ironically, it would ultimately cost them a lot more money in the long run if I remained untreated and eventualy develop liver failure. Pardon my cynicism but I just don’t trust the insurance companies!