Aa
Cost of medication for treatment
For those of you who are willing to share, if you have a prescription plan on your health insurace, how much on average is your co-pay for INF, RIBA, and if nececessary Procrit.
Right now I am on medical leave of absence from my job. I am barely making it just to pay the bills and food. I am trying to make a decision as to whether I should go back to work and just tough it out during treatment if I cannot afford the medication in my current situation.
Thanks for any input!
Right now I am on medical leave of absence from my job. I am barely making it just to pay the bills and food. I am trying to make a decision as to whether I should go back to work and just tough it out during treatment if I cannot afford the medication in my current situation.
Thanks for any input!
You know sometimes I can't figure out if you are joking, or really asking a question.
I take it you are asking a question
If I leave the pool I will be without insurance, but I can leave anytime.
The group plan from Blue Cross I referred to was purchased as an individual plan, meaning as a self employed person, and was not through an employer.
Never the less, it was a group plan, and needed the insurance commissioners approval to enact any changes.
When anybody wants to purchase health insurance as an individual, you have to fill out a questionare (300 questions). Each disease has a number of points assigned to it. If you reach a total of 290 points, you will be rejected.
Chronic Hepc receives 600 points, so you are automatically disqualified.
The questionare was designed by the insurance commissioner, and not the health insurance companies. It gets updated every so often, but no changes have been made to chronic Hepc, still considerd not curable.
All insurance companies in the state of WA follow the same rules.
So if you are rejected by one company, you know you will be by others as well.
The rejection letter is your admission ticket to the pool, they must take you. They offer different plans, with different co-pays and deductibles. Mine is a middle of the road to better plans.
The pool is funded by the high premiums members pay, as well as the insurance companies. By law, all insurance companies that sell health insurance in this state, have to contribute mightily to the pool. In return they get to cherry pick their members.
If I were to seek employment, I would of course be accepted by the insurer the employer had to offer.
I am not seeking employment though. Some 15 years ago I gave up salaried work, and chose to make my fortune/lossse in the finacial markets. Due to tx I have not worked for 3 years, so that's why I am beefing so much about high premiums, and shop in Good will stores.
Some people don't call my work work. If they only knew...I do all my own reseach.
Ina
I take it you are asking a question
If I leave the pool I will be without insurance, but I can leave anytime.
The group plan from Blue Cross I referred to was purchased as an individual plan, meaning as a self employed person, and was not through an employer.
Never the less, it was a group plan, and needed the insurance commissioners approval to enact any changes.
When anybody wants to purchase health insurance as an individual, you have to fill out a questionare (300 questions). Each disease has a number of points assigned to it. If you reach a total of 290 points, you will be rejected.
Chronic Hepc receives 600 points, so you are automatically disqualified.
The questionare was designed by the insurance commissioner, and not the health insurance companies. It gets updated every so often, but no changes have been made to chronic Hepc, still considerd not curable.
All insurance companies in the state of WA follow the same rules.
So if you are rejected by one company, you know you will be by others as well.
The rejection letter is your admission ticket to the pool, they must take you. They offer different plans, with different co-pays and deductibles. Mine is a middle of the road to better plans.
The pool is funded by the high premiums members pay, as well as the insurance companies. By law, all insurance companies that sell health insurance in this state, have to contribute mightily to the pool. In return they get to cherry pick their members.
If I were to seek employment, I would of course be accepted by the insurer the employer had to offer.
I am not seeking employment though. Some 15 years ago I gave up salaried work, and chose to make my fortune/lossse in the finacial markets. Due to tx I have not worked for 3 years, so that's why I am beefing so much about high premiums, and shop in Good will stores.
Some people don't call my work work. If they only knew...I do all my own reseach.
Ina
I had a Blue Cross Plan with unlimited drug coverage.
My copay for drugs was 20%, which came to about $430 a month.
One day I got a letter, telling me that my group plan was going to be replaced with another one.
The new plan was identical to the origional one, except for the drug coverage part. Drug coverage was capped at $5000 a year. That would have covered 2 month of Peg and Riba.
That was one of the most stressful events during tx.
Every other insurance company rejected me.
I wound up in the pool for the uninsurable, which has unlimited drug coverage. My copay for the remainder of tx was $30.
My monthly premium in the pool is $945, in Jan it will go up to $1200 a month.
I can't leave the pool, because my state does not recognize that some of us get "cured" from Hepc. I am considered not curable, even though I am SVR.
Ina
My copay for drugs was 20%, which came to about $430 a month.
One day I got a letter, telling me that my group plan was going to be replaced with another one.
The new plan was identical to the origional one, except for the drug coverage part. Drug coverage was capped at $5000 a year. That would have covered 2 month of Peg and Riba.
That was one of the most stressful events during tx.
Every other insurance company rejected me.
I wound up in the pool for the uninsurable, which has unlimited drug coverage. My copay for the remainder of tx was $30.
My monthly premium in the pool is $945, in Jan it will go up to $1200 a month.
I can't leave the pool, because my state does not recognize that some of us get "cured" from Hepc. I am considered not curable, even though I am SVR.
Ina
eisbein: So you're in the pool for forever? You can't just quit?
Lindy: I paid about 100 bucks a month for meds, including procrit and neupogen. I didn't realize until late in the game that my labs were not being covered to the level I had hoped - costing a smalll fortune. I still don't know what all was going on there, I have to haggle through it with ins co when I get so motivated.
Lindy: I paid about 100 bucks a month for meds, including procrit and neupogen. I didn't realize until late in the game that my labs were not being covered to the level I had hoped - costing a smalll fortune. I still don't know what all was going on there, I have to haggle through it with ins co when I get so motivated.
I received a month's supply of riba and peg-intron redipen after I paid the 100.00 copay. I have Blue Cross/Blue Sheild. Ironically, I haven't started yet and I have this small fortune worth of drugs in my refrigerator and medicine cabinet.
I was at 9.8 when I started. But I also did not start Procrit until I switched docs and my first doc had already cut my Riba dosage in half in an attempt to combat the anemia. If she had noticed the rate at which my Hgb was dropping and administered Procrit much earlier, I think I might have avoided having my Riba dosage cut in my first 12 wks and my entire treatment eventually bollixed.
Of course, I can not say for sure that I might not still have wound up being a nonresponder, but most studies seem to stress the importance of maintaining full med dosage during the first 12 wks as being critical towards increasing ones chances of attaining SVR.
For most of tx, I was bouncing from 9 or less to 10.5 even while on the Procrit. The other irony is t hat when I was pulled from tx a week ago, my Hgb actually registered as 11.2, which is the highest it has been since the wk 2 of tx nearly 10 months ago.
Of course, I can not say for sure that I might not still have wound up being a nonresponder, but most studies seem to stress the importance of maintaining full med dosage during the first 12 wks as being critical towards increasing ones chances of attaining SVR.
For most of tx, I was bouncing from 9 or less to 10.5 even while on the Procrit. The other irony is t hat when I was pulled from tx a week ago, my Hgb actually registered as 11.2, which is the highest it has been since the wk 2 of tx nearly 10 months ago.
My Interferon and Riba are $10 a month together on Healthnet. I get my procrit/neupogen at the hemotologist so they are an office visit at $10. My ins. will end in about six months as I am on Cobra, since I am not working now. I need to find new ins. which sounds daunting to me...
The expense of tx is a big consideration when you decide to tx, or not. You should check thoroughly with your insuarance carrier. As you can see, out of pocket costs vary widely across patients. My insurance (Aetna) covers the Interferon within the coverage of the medical policy, the riba is covered by the pharm part of the policy. Deneding on what your insurance will/will not cover you could then look into patient assisance programs. Coverage, and accessibility to all drugs is an important factor to nail down before you decide/start
Hi Lindy, the co-pay under Oxford is $60/mo., which is $25 for the peg-intron, $10 for the Ribapak, and $25 for Procrit. (They also approved Procrit in advance of starting treatment, and without the hemoglobin count having to drop to 10 as many others have reported here.) But there are many plans Oxford offers and this is the one that comes with a premium of about $420/month (single coverage, $450/mo each for family) for the entire coverage package.
Good luck!
Good luck!
Could anyone tell me how much you pay for Procrit or Epogen. Are these drugs taken once a week or more often? Do you continue them throughout treatment, or only until your red blood cells increase? Thanks!
Patient assistance programs are also for those WITH health insurance who's copays are prohibitive. They are also for
"middle class" folks and have generous qualification standards. They are not indigent programs, you can work, earn a decent living, own a home and qualify. It is well worth applying.
"middle class" folks and have generous qualification standards. They are not indigent programs, you can work, earn a decent living, own a home and qualify. It is well worth applying.
My copays for both drugs ran 600.00 a month, not including any "rescue" drugs. I contacted Commitment to Care and they supply my drugs ( and many others here) to my door for free. If you take PegIntron their number is 800 521 7157. If you take Pegasys go to their website at Pegassist.com, they have a similar program. They have very generous qualification standards and it is fast and easy to apply. They did take my ins. info. I dont know if they receive payment from them or not but I don't have copays to cope with nor did I have to fight with the ins. company to get them to pay. Also I didnt have to worry about them denying my claim when the first tx. didnt work and I needed another year of meds, Commitment to Care came through again.
Consider what you do with those meds. Since I had to deal with some rx restrictions the abilty for me to increase Peg dose was due to a person like you. He, or she, turned unused meds to the doc. I managed, through the thoughtfulness of that patient and the kindness of the doc's office (not my tx doc, by the way) to have the meds in hand that gives me the best shot of getting outta here someday.
I've been giving that some thought, which is why I haven't disposed of them yet, but not sure how to go about providing them to someone who needs and can put them to use.
I've considered raising an offer when our local support group meets this Tuesday evening in the event that someone local needs them and can benefit from them.
I've considered raising an offer when our local support group meets this Tuesday evening in the event that someone local needs them and can benefit from them.
I am self insured with Unicare. I am on a PPO. My co-pay for Peg-Intron was $285. per month. On the other hand, my Riba was only $30 per month. Back to the negative side...way negative..I became anemic very quickly. My co-pay for Procrit was $495 per month. Roche and Schering both have assistance programs that you may qualify for.
The cost and frequency of injections varies depending upon the dosage you are taking. As I indicated in another thread, Procrit comes in 10,000, 20,000, and 40,000 U/ml vials and each is priced differently.
I originally was only doing a single injection per week, but after reaching 100,000 U/wk and Hgb still fluctuating I was moved to two and finally three times a week for a total of 100,000 U/wk dosage. The multi-injection per wk was done to try and maintain a more consistent level of Epogen in my body throughout the week.
I originally was only doing a single injection per week, but after reaching 100,000 U/wk and Hgb still fluctuating I was moved to two and finally three times a week for a total of 100,000 U/wk dosage. The multi-injection per wk was done to try and maintain a more consistent level of Epogen in my body throughout the week.
Part of the irony of being pulled from tx is having to toss out 3 injections of Pegasys, over 3/4 a bottle of ribavirin, 14 vials of 20,000 U/ml and 6 vials of 40,000 u/ml of Procrit.
Actually having to toss all these extra meds drives the waste of 10 months of meds and their associate costs more directly home.
Actually having to toss all these extra meds drives the waste of 10 months of meds and their associate costs more directly home.
Hello, thanks again for helping me with this. How low was your Hgb when you started Procrit. I called my Dr's office twice now (once yesterday and once today) and still have yet to hear back. It's 10:08am here so I guess they will call sometime today. I feel like they should have called me with the results as everything I read states I'm anemic and on the border of becoming severly anemic. I just know you will be fine. You have to stay positive and keep looking for answers. You will find them in time. Best wishes to you!
Over the 10 months of my failed attempt to defeat this insidious disease I've spent all told about $2,000 dollars to cover co-payments for meds, docs, surgical procedures, etc..
Perhaps that also is what makes it's failure harder to accept in that I could have just as easily donated that money to a worthwhile charity for all the good the tx did me.
Perhaps that also is what makes it's failure harder to accept in that I could have just as easily donated that money to a worthwhile charity for all the good the tx did me.
I have Blue Cross. The copay for my Ribavirin is $10.00 & for my Peg-Intron Redipen, its $25.00.
-E
-E
Hi, I am self insured through Unicare and I am self employed. My copays are roughly $400/month with my PPO. Most of that is for the interferon and only $10 for the generic ribavarin. I think if I was covered through an employers insurance benefits group it would be cheaper for me. I know there are good assistance programs out there from the drug manufactures. Speak to your doctor's office and they can direct you depending on the manufacturer of the drugs you will be on. Take care!
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