Insurance Question

[iwillbeatthis]

Am finding out the 'routine' of getting the Riba and Peg. Is it a safe assumption if you are covered for the Riba that you'll be covered for the shots?
Thanks,
Bree

[iwillbeatthis]

Man, how funny, yes good climate, yes windy, the Dam Bar is still here, and so are the Hualapai Mountains :)  I just sent you an email.
Bree

[pcds]

Gosh Bree, I lived in Kingman 1977.  Worked at mohave mental health center.  Great climate, although windy.  Lived there only 2 years.  I remember the Dam Bar and of course Walipai mountain.
Judy

[iwillbeatthis]

I'm in Kingman! And I'm always home. We work from home.
So far, my Riba is no $, no copay. Just working on the Pegasys.
I would be good with $100 copay for the shots. We'll see.
Gosh Judy, we are neighbors :)
Talk to you soon,
Bree

[pcds]

The ribavarin is cheap as it's generic, cost me $7 per month copay. The pegasys came air delivered, on ice  so start to think about where it will be delivered.  If you go to work, and won't be home, they will not deliver and leave outside in the summer at least depending on temp.  I'm in Phoenix, if you were in Montana it may be different.  My co pay was for the injectable was $100 per month. So my total for both per month was $107.  I was surprised thought it would be more.
Just to give you a point of comparison.
Judy

[iwillbeatthis]

Thank you again Bill, you're terrific. You know I'm going to ask the doc, and you know I'll let you know.
All of you here are just the best. (Going to go eat and eat, I have my fast coming up tomorrow for the scopes, it turns out I will have about a 36+ hour fast.)
Bree

[Bill1954]

Gosh, that’s a very good question, and one that’s been posed and debated in here ad nauseum :o).

There have been studies that have done head-on comparisons between the two drugs, and it seems they are very similar in regards to efficacy/SVR. Here are a few you can glance through if you’re interested:

http://www.hivandhepatitis.com/hep_c/news/2008/071808_a.html

“Adjusted indirect comparisons found no statistically significant differences between dual therapy with pegylated interferon alfa-2a and dual therapy with pegylated interferon alfa-2b with regard to sustained virological response (SVR), withdrawal due to adverse events, anemia, depression, or flu-like symptoms.”

Probably the largest one of it’s kind was the IDEAL study; here is an expert’s overview of the results:

http://www.hivandhepatitis.com/hep_c/news/2008/011808_a.html

And many, many more…

http://www.google.com/cse?cx=000772985894926410863%3Awvp_6dwxpvm&cof=FORID%3A0&q=compare+pegasys+with+pegintron&sa=Search

With cost probably being the same from the insurance company, the biggest difference might be the manufacturers. Some patients have reported easier side effects with Pegasys, however, I’ve done both and didn’t personally notice any difference. I got SVR from Pegintron, so perhaps my view is a bit biased :o).

Pegasys is one size fits all; they provide 180 µg/week, while Pegintron uses weight based formula and offers different doses for different body weights. This might be of some importance if you fall outside the bell curve with body weight/BMI.

Lots to consider, huh :o)? You might ask your doctor which one he prescribes, and why; it’d be interesting to get his take on it.

Good luck—

--Bill

[iwillbeatthis]

Thank you Bill.

I've heard both here Pegasys and Pegintron.
Same question about the INF alpha 2 a and b.
What is the difference? Why do the prescribe one over the other?

[Bill1954]

Sure, you can call and ask; I mean, it’s not like they won’t find out, eventually, right? I imagine you will eventually be prescribed either:

Interferon alpha 2a (Pegasys) (+ribavirin)
Interferon alpha 2b (Pegintron) (+ribavirin)

There are various delivery systems; e.g. a traditional syringe vs. ready-pen, etc; and there are various dosages available with the Pegintron; but this should be enough info to get copay information, and perhaps to check if prior authorization is an issue with this policy.

--Bill

[iwillbeatthis]

OK, thanks, hopefully my insurance will cover, if not, this is good info.
Do you think I can call my insurance and ask?
If so, what is the exact technical shot I am asking about?

[Bill1954]

Bree, the patient assistance programs are set up to help with uninsured as well as underinsured. Yes, I had Medicare at the time and had Part D coverage, but the copay was really high; around $600.00/month if I recall.

They do have income parameters to qualify a patient; but these are income rather than asset based; you can own property, income property, business, etc; qualifying is based strictly on income…

--Bill

[nygirl7]

You should be covered but most likely have a copay involved.  The riba without the peg makes no sense and would be worthless (unless you are trying to fight the bird flu) because it would not work in a million years.

48 weeks of the meds (both) I believe comes to about 20k however during the course of treatment many other drugs can be needed and I figure my 72 weeks cost about $200,000 for treatment.

However at the time I extended it was considered by Aetna (my insurance) experimental and they would not cover the additional six months.  Comittment to Care (I was on PegIntron) covered every single penny of the meds for me while my insurance covered the doctor bills, tests and other meds.

You should be fine either way.

[iwillbeatthis]

You mean you had insurance but still went to the program?
I guess you have to fall into some perimeters to qualify?
Thanks for the info, I'll see what happens with insurance and then go from there.
Bree

[iwillbeatthis]

Yea I found out so far that I'm covered with the Riba, and am waiting to hear back about the shots. How much do these shots normally cost?
Bree

[Bill1954]

If you run into seemingly insurmountable obstacles, here are the patient assistance program numbers just in case:

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

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

Just call the appropriate number, and the service rep will help you apply.

Bill

[Bill1954]

Not necessarily, Bree. Well, actually you might be covered, but to what extent is often the case. Some insurance policies cover the riba under their Rx plan but put the IFN into major medical, sometimes requiring 30% copay. That happened to me, and while I paid the first time out of pocket, the second treatment I went through the mfgr’s patient assistance program; they paid for 100% of both meds, with no copay or deductible to meet.

Also, these drugs often require prior authorization; sometimes that can take a week or more to arrange. It’s not quite like filling a prescription for penicillin or something; it’s often a bit more involved.

--Bill