Hi all. I have some questions about cost of treatment. My husband's company sold this month and we are trying to decide between two different insurance programs (both PPO). I have no idea what I'm looking at cost wise and it will make a difference in which one we go with. I'm Genotype 1a-CT, Stage 2, Grade 3. Assuming I do triple therapy for 48 weeks, any general estimates? I hate dealing with this part of it. I told my husband to just shoot me and bury my by my two cats. That would be cheapest. :) Seriously, any help with this would be appreciated. We have to make a decision soon.
Here is my general advice in a nut shell: Get a good insurance plan. This treatment costs a lot. Plus, you do not yet know how treatment will go and what, if any, complications you may have or what, if any, adverse reactions you may have.
I don't know what your options are but getting good coverage is imperative. The meds and the tests and the MD visits will nickle and dime you to death even with good coverage. If you have poor coverage, then the money becomes a big issue.
To be more specific.....
Doctors vary. I went every week for 12 weeks, then every month.
Blood Counts every week or 2 weeks
Metabolic Panel every month
Viral Loads periodically (at least weeks 4, 12, 24 and probably more)
Clotting tests periodically
Potential other blood tests depending on how treatment goes
Potential other tests such as X-rays, Sonograms, etc.
Then add on any other Prescription Meds you may need:
Meds for Rash (I had Hydroxyzine, Clobetesol, Flucinonide, Hydrocort Val)
Meds for Nausea/Vomiting (I had Zofran)
Antidepressants (I had Wellbutrin)
Plus you may need over the counter medications and supplies. I was spending $150 to $200 every month just on over the counter supplies. Then I had my Prescription Med co-pays also.
I had some problems during treatment so I ended up needing Electrocardiograms, Echocardiograms, Cardiology appointments, Event Cardiac Monitor for a month, Sonograms. That added to the cost. Of course, more blood work too, which added to the cost. (They wanted to do a cardiovascular stress test too but I was too weak and dizzy to walk so I never had it, LOL. I told them I would pass out, and I would have.)
PS: I have good Ins. coverage. I paid a $70 co-pay for the Incivek, Pegasys, and Ribavirin every month. When I went off the Incivek, then my co-pay was $25 a month for the Pegasys and the Ribavirin. My other co-pays varied depending on the tier the drug was on. I forgot to mention I was also on Restasis for my eyes. That was a $45 co-pay a month because it is tier 3. (If I did mail order I could get 3 months for $90).
Also, my ins. covered a good potion of the other costs. I have a yearly deductible that I have to meet before they will pay anything. After that, the ins. co. picks up their part and I pay mine, but my part is small after I get the yearly deductible out of the way.
2,000 deductible/4,000 max out of pocket with drugs and copays going toward deductible and deductible going toward max oop. It's basically an 80/20 until max is reached.
500 ded/3,500 oop, drugs and copays don't go twoard ded and copays still apply even after oop has been met. Still have to pay for drugs even after oop has been met.
So, I think you answered our questions. :) We're going to go with the first option. We'll pay a higher deductible, but after max oop we'll owe very little if anything. Thank you so, so much, Pooh. I'll keep you posted and you do the same. :)
I agree with you that going with the first one is a good choice. That is what I would do.
With mine, I have two sections, the medical insurance and the prescription drug insurance.
The prescriptions are separate from the rest. So, I have no deductible with the prescriptions, but always the co-pay. The prescription co-pay does not go towards the medical deductible.
The medical deductible is $250 per year and that is met by any costs other than prescriptions. So usually a couple of tests or doctor visits and I have met my yearly deductible.
I just want to mention that having good insurance is very important even if you did not have Hep C. Hep C treatment is expensive, but it is not the only disease with expensive treatments. Cancer treatments can be very expensive as are transplants and treatment for any number of diseases. People often skimp on insurance but then they get hit hard if they get sick, especially if they get sick with a long term illness or a life threatening illness. So I agree with you that going with the first one is a very good choice.
I agree with you. The higher deductible, will give you better coverage over time. My husband has Regence through his work and it's been OK. I think we paid about $90 out of pocket monthly for his treatment meds and maybe about $35 copay per other prescriptions. I think his appointments were covered at about 80% and lab tests were similar.
my insurance is good but prescription drug coverage has a 230.00 deduct. per year. I dont pay anything for Dr and labs. but my med is different I did 24 weeks of rib and peg. My first month was 930.00 and the next 4 weeks was 1980.00 then it dropped the 3rd month to 830.00 then the 4th 5th and 6th months was about 160.00 each month some generics were 2.60. I was out around 4900. total for all the year beside my monthly premium on the drugs itis a seperate premium to the other Ins.
check the coverage for tier 5 drugs . Good luck
meds in Canada are insanely cheaper....example...Xifaxan 550 x 2 a day in US between $1250 - $1400 a mo. depending on where you go...same script in Canada $170 - $200 a mo. ...my pharmacist says we in US pay higher drug costs than any other country for same drug...asked my liver specialist about getting drugs in Canada and he veto'd it. Also if prescribed tx and insurance, if you have it or, if you don't, will pay for the Incivek. If you are in a study the interferon and ribavirin can be picked up by the drug companies too with appropriate letters from your doctor. If you had great insurance with husband's company pick up the Cobra even though it will be expensive but it will continue to pay for everything for the next 18 months just like you have been getting. Could be worse...I am 65 on Medicare with supplemental...good insurance...and you still fall into doughnut hole where you have to pay out the wahzoo for your scripts to meet your deductible. And yes, we need some kind of healthcare reform...... if you go on medicaid they control your life so I am trying to deal but who knows what comes next...the posters before me gave you some good advice...think about Cobra...might save you money in the end.
Copyright 1994-2016 MedHelp International. All rights reserved.
MedHelp is a division of Aptus Health.
This site complies with the HONcode standard for trustworthy health information.
The Content on this Site is presented in a summary fashion, and is intended to be used for educational and entertainment purposes only. It is not intended to be and should not be interpreted as medical advice or a diagnosis of any health or fitness problem, condition or disease; or a recommendation for a specific test, doctor, care provider, procedure, treatment plan, product, or course of action. Med Help International, Inc. is not a medical or healthcare provider and your use of this Site does not create a doctor / patient relationship. We disclaim all responsibility for the professional qualifications and licensing of, and services provided by, any physician or other health providers posting on or otherwise referred to on this Site and/or any Third Party Site. Never disregard the medical advice of your physician or health professional, or delay in seeking such advice, because of something you read on this Site. We offer this Site AS IS and without any warranties. By using this Site you agree to the following Terms and Conditions. If you think you may have a medical emergency, call your physician or 911 immediately.