Cost of Tx

[daniel2u]

I am counting my blessings this morning.  My Pegasys plus ribavirin Tx is paid for.  I am wondering how much this Tx would have cost me.  
Daniel

[mike716]

Really? So then Medicare might be the solution for me. Thanks. I'll certainly keep that in mind as I fight my way through the miasma of third-world treatment here.

Mike

[Trinity4]

No pre-existing applies to medicare. After you pay deductible of $238.00 everything is covered at 80%.  Everything.
Trin

[mike716]

So I could get treatment there after one year with private insurance? I wonder what the Medicare story would be.

The income limit problem is that they don't seem to average it over, say, the past five years. If they did, I could qualify. But last year I switched a lot of investments and they don't see what I bought, only how much I sold.

Anyway, the docs aren't so bad down here, and the lab work and tests are very good and dirt cheap. So I'm not going anywhere for the moment. If and when I start tx, I'll have to make a decision.

[Trinity4]

Yes, by law they must pay because I have had private pay insurance for 1 year with no break in coverage.  Pre-existing clause does not apply with group coverage if you have maintained coverage and I have.  If I hadn't had any coverage and went on my company's group it would have been considered pre-existing and they would add a clause which denies treatment coverage for one year I believe.  Also, regarding your income, whatever amount you are actually paying taxes on yearly is considered earned income.  
Trin

[mike716]

Thanks for the info and good advice re costs. I think I scr**ed myself by selling a bunch of investments in 2007 and reinvesting the money in something else. I actually am living on around $25k/year, but it doesn't look like that from my tax statements.

I'm getting less and less happy about treating down here in Buenos Aires, what with all the problems I'm having with the doctors and the labs. I'm gonna wait and see what they propose re tx, but if it's expensive I'll get right in touch with Schering. Maybe I'll do that anyway instead of waiting.

What is the rx you've got starting in July? Will they really pay for a previous condition like your hepC?

Mike

[Trinity4]

Mike,
I initially went through Schering Plough and I think the cap was around $75,000 earned income.  Not what we have in the bank, just what we make.  That would have been combined - mine and hubby. He is retired and I don't make alot of money and was approved immediately.  They did not want to know about any of my assets, bank accounts, properties, etc.  Very liberal.  My doctor, unbeknownst to me, was working on getting meds for me through the Roche drug rep so I just let his office take care of it and don't have to pay for them.   I did not have rx coverage at the time so it worked out well.  I will have rx coverage starting July 1st and after I pay $1500 out of pocket all my meds, doctor's visits and labs are covered 100%.  Pretty sweet deal!!  If you plan on coming back to the states, contact Schering Plough or they may be able to help you while you're in Buenos Aires.  Definitely worth checking out - Schering Plough Commitment to Care Progam.
Trin

[mike716]

Is that $75k income or savings?

[daniel2u]

I'm sorry for not answering your question of who pays for my tx.  To be honest with you I don't even know.  I will find out from my doctor when I see her on Tuesday.  
Daniel

[Isobella]

Just being  curious I called around to 3 pharmacies to check prices.  They varied by hundreds of dollars. All 3 stores were within 1 mile of each other!  Winn Dixie was by far the least expensive.  

Doing a rough total though, if my insurance doesn't cover any, my cost -with some procrit added in- was about $100,000.

[JadedWarrior]

Roche gave me mine for free. I meet the fed govt poverty scale of less than 75k. YES I EVEN WORK and own my own company.


They approved me for a year straight on a 24 week treatment. So I will have left over possible should doctor not go past 24.


Rep told me yesterday tx runs 26k a year.

[daniel2u]

My medication sheet, or what ever you call the page that has instructions warnings etc for my interferon showed the cost.  I never cost printed on the slip.  For four injections it cost $2,498.09.  That is over $600.00 per injection.  I am shocked.
Pax
Daniel

[mike716]

I wonder if "earned income" for them would include sales of investments. I guess the only way to really know is to talk to them, or apply.

[mike716]

Thanks a lot. I'll try and contact them.

[can-do-man]

Mike, during my tx when i reached 48 weeks i was unsure if my insurance would pay to to extend tx meds for 72 weeks, while waiting i called SP. Told them of my not knowing if insurance would cover.

The lady i spoke with was very nice and told me only our earned income would count. They didn't care about my rental income or other assets i had. My income alone was over 30k a year, my wife also was working (but does not carry insurance) I was lucky and my insurance gave me no problems but i was told by SP they would cover the meds if they did. Their commitment to care is very liberal.... Best to you

Bill, been a while, i take it your still on your LOOOONG tx. journey??? Sounds like you still got it together. Hope all is well with you.

can

[Bill1954]

HI Mike,

I can’t directly answer your question regarding their income cut-off point. They seem to hold that fairly close to their chest; I can’t tell you why. I CAN tell you that this assistance is not designed solely for the indigent population; it’s set up for the working poor in this country as well. A wild guess would be around 30K yearly, but it might vary substantially.

While I believe SP’s Ready-Pen delivery system requires refrigeration, the old-style vial-and-syringe does not. Both are commercially available; although SP *may* only dispense the vial-and syringe product through their PAP.

I bring up the refrigeration issue because one product might be more amenable to overseas shipping than the other, if you get my drift :o).

Hmm, contacting them might pose a problem. They have a toll-free number (1-800-521-7157), but I doubt that number connects with overseas calls. You can sure try, though. Here is a little more from HCV advocate:

http://www.hcvadvocate.org/hepatitis/factsheets_pdf/PAP.pdf

I also seem to recall an online registration form available in PDF; you might be able to fill and fax to Commitment to Care, but I imagine at least some phone correspondence will be needed.

Let us know how things go.

Take care—

Bill

[mike716]

Thanks very much for your help with this, Bill.

Well, I'm a U.S. citizen and have an address in New York, so I could always come back home to qualify.

Let me see if I've got this right. Schering-Plough, if not Roche, will provide all the meds (or at least the two principal ones) to someone whose income last year was low?

Do you happen to know what the cut-off is? I have a very low income for a retired American, which is why I ended up coming to Argentina for dental work. But last year I cashed in some annuities in order to reinvest them and pay the dentist. If Schering only looks at last year, that might disqualify me. Sounds like a bad system.

But it's worth a try. Can't hurt to ask them. Is there an info service at Commitment To Care? How do I contact them?

Mike

[Bill1954]

Hi Mike,

I can’t speak for Roche, but Schering-Plough’s program is income based, rather than asset based; i.e. Bill Gates might qualify if he’d had an off year.

They never questioned my assets, nor was I asked to fill out any financial statements, other than to provide the last year’s federal income tax info.

However, you probably have to reside in the U.S. to receive the meds; this needs to be verified with Commitment to Care, though.

Best to you—

Bill  

[mike716]

Wouldn't I have to give them what I've saved up for my retirement first?

Mike

[HectorSF]

What about trying to get your meds for free from the U.S. pharma companies?

To learn more about the Roche Patient Assistance Foundation (PEG and Copeg) and our individual product programs, call our toll-free number 1-877-75ROCHE (877-757-6243). To learn more about the extensive list of pharmaceutical industry-sponsored patient assistant programs, access www.pparx.org.

Good luck!
Hector

[mike716]

Thanks, Marcy, you're a doll.

M.

[Marcia2202]

glad to hear it went well.

marcia

[mike716]

Hi, Bill. Thanks for your informative post of 5/20. I'm okay for the time being here in Buenos Aires. I have the in-house health plan at a pretty good hospital and so far everything has been covered: blood tests, ecodoppler for portal hypertension, endoscopy for varices, and a biopsy two days ago. Everything's negative so far, by the way, so maybe my liver isn't too bad yet. But I won't have the biopsy results until mid-June. They're very slow here.

Meds costs are gonna be a problem for me, like they are for a lot of others. My brother in New York thinks I should go back there and try to get on Medicaid. But that could take a long time.

No point in speculating on alternatives until the biopsy comes back, I guess.

Thanks again for your help.

Mike

[Bill1954]

This treatment *is* expensive. I was fortunate enough to qualify for social security; Medicare picks up the medical expenses, and at this time, Schering-Plough’s Patient Assistance Program pays the hepatitis Rx expenses.

Liver transplants are another issue entirely; I’d want very good insurance going in; I’ve heard of costs exceeding 700,000 USD, and I don’t know if that’s current. Additionally, a TP patient will need expensive monitoring and a lifetime supply of anti-rejection meds to boot. I’ve heard the American Liver Foundation has *some* available funds available for indigent assistance, but I’m unclear about that as well.  

I’ve been on treatment since Feb ’05 with a four month respite between treatments. As a genotype 1 patient with late fibrosis/early cirrhosis, diabetes, etc I am considered a hard-to-treat patient, and have relapsed after the initial treatment period of 56 weeks. Additional treatment is sometimes necessary for viral eradication. I’m currently in week 89 of a scheduled 96 week treatment period with high-dose riba and IFN.

Do I have any hair left? LOL, Hell no, but I can’t blame that on treatment. I’m a follically challenged individual. Honestly, hair is the least of my worries right now :o).

Keep reading in here, and elsewhere; there are ways to get help, but the treatment sill still not be free.

Take care—

Bill

[smaug48]

where the *** is in the url, insert   needymeds

smaug