A cheper way to chemo?

Portal Forums Cancer Basics Oncology Economics/Industry/Policy A cheper way to chemo?

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This topic contains 9 replies, has 4 voices, and was last updated by  flovesee 4 years, 3 months ago.

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August 20, 2013 at 1:19 pm  #1258703    

flovesee

Hello,
I just received my EOB from my insurance and found that my doctor is charging my insurance $12,160. for each dose of my Alimta maintenece chemo. After contract savings it brings it down to $4,636., of which insurance pays 3,709. This leaves me with a 900. payment due every 21 days. I have found that a dose of Alimta is approx. $3,000. for a prescription.
My question is, would a person be able to have a doctor (hopefully oncologist), write a prescription that could be filled at almost any pharmacy, and have that prescription be administered at their doctor’s office, with appropriate anti nausea, viamin B shot, etc. There simply has to be a cheaper way for me to get this medicine without such a grossly inflated price. I am doing fine and I am hoping the Alimta will be helping me for a long time. Any thoughts on this subject would be greatly appreciated. I have insurance but am on a fixed income. I have been fortunate to have had copay relief in the past but I do not think it is fair to ask for help if I can find a cheaper way from the start. I have already found the drug at 1/4 the cost my doctor charges…..

August 20, 2013 at 7:34 pm  #1258706    
Dr West
Dr West

Unfortunately, I don’t think that’s really possible: I have never heard of that and don’t think it’s feasible to treat Alimta or other chemo as if it’s an outpatient medication.

Many people are very happy with Alimta (pemetrexed), but not because it’s a bargain: it’s pretty expensive, and some other alternatives, such as Taxol (paclitaxel), Taxotere (docetaxel), or Gemzar (gemcitabine) are considerably less expensive options that might be prioritized if cost is a big issue.

-Dr. West

August 21, 2013 at 7:53 am  #1258711    

flovesee

Thank you for your reply Dr. West. Of course as a chemo patient for a year now I know that cancer is not a bargain in any way shape or form. I guess I just get upset at the amount of inflation of the chemo prices when I know doctors can get the drugs themselves for a discounted price. I also I do understand that this inflation helps offset the costs of running the cancer centers as businesses. But may I ask one more question? If a patient came to you and asked for a discounted price, would you consider their request? I am going to ask my doctor, it can’t hurt.

August 21, 2013 at 9:58 am  #1258713    
catdander forum moderator
catdander forum moderator

flovesee, there’s often advisors at cancer centers that help patients with bills. I’d hope there would be an avenue to be taken that would lower the balance due. Usually insurance companies and pharmacies and cancer centers make deals that create less monthly burden. If not there are grants from drug manufacturers that help. It will worth a call to the cancer center and ask. If they don’t have someone to help, ask them if they have other resources. You can’t be the only one on alimta at your center who has trouble paying 900 every 3 weeks. If that’s not helpful a call the to manufacturer is the next step I’d take.

Let us know what you find out.
Janine

August 21, 2013 at 10:16 am  #1258714    

flovesee

I will, my next chemo is next week. I had an epiphany last night…Someone would make a MINT creating chemo centers, that just administered chemo. The doctors would refer patients over to the center. The patients would have prescriptions for their chemo that could be filled, then administered (with a (one) doctor, and nurses on site of course), in a nice setting. Cheaper for insurance companies, patients, and better for the economy as a whole. After all I go somewhere else for my scans, even though they offer them in their office….I just prefer a certain place to have them done, where they are quick and efficient insted of crowded and behind schedule ( and they are awesome in their billing arrangements).

August 21, 2013 at 11:44 am  #1258717    
catdander forum moderator
catdander forum moderator

It sounds like you’re in a difficult situation. My husband’s cancer experience I’ve found mostly excellent care, treatment, business practices, and all around help and support just for the asking. Very unlike other hospital/doctor experiences in which I’ve been involved.

My thought on separate infusion centers is the more your care is farmed out the more likely a miscommunication can lead to disastrous results. But we’ve probably been lucky to be close to such an excellent run center. The cancer ward of the hospital is even amazing and I’ve been all over that hospital and sometimes even scared to leave a loved one.

Best of luck,
Janine

August 21, 2013 at 10:00 pm  #1258724    
Dr West
Dr West

I have no remote control over the cost of medications or anything else at my center, and more and more doctors are part of large systems that have no more influence than if you were to go to your local national chain and ask an employee if you could get a lower price for something on the shelf.

The best I can say is that the difference in efficacy between Alimta (pemetrexed) and a much less expensive drug like Taxol is relatively minimal, if any, and far, far less than the cost difference. Oncologists usually have somewhere between extremely minimal and no control over the cost that patients are charged, but different drugs can be recommended that differ greatly in what they cost.

-Dr. West

August 22, 2013 at 8:13 am  #1258732    

flovesee

Thank you for your reply,
I have already done a first line with Avastin, Carboplatin, and Paclitaxel. I have had a full genetic analysis, from CARIS, of my tumor(lung ), material and it does show that paclitaxel is shown to be a benefit for me (but not carboplatin). I do like the Alimta and find it easy to take, and I hope it is working. I have not had my scan yet. I will talk to my dr. and their billing department. Who knows, maybe the squeeky wheel will get the grease. I’m okay either way. I have to remember not to get worked up over the injustices (what I perceive, though maybe not neccessarily so) in life.

August 22, 2013 at 9:04 am  #1258734    

mikem

Hi flovesee,

I don’t know what insurance you have but doesn’t it have an out of pocket maximum? When I was on Alimta once I reached that point, I never paid for anything after that during the same calendar year.

I’m not sure how you were able to find a prescription cost for Alimta. When I was taking the drug they made it up right at the center/hopsital day of infusion. It had to do with my stats and blood work, so I don’t think a one size fits all prescription would work.

The other thing I remember about the insurance was that the Alimta was part of a billing for therapeutic services. I don’t know if that would have anything to do with it but I would check with the insurance about the maximum payout. It seems you are paying the normal 20% but it should all be covered at some point. –mikem


56 year old former smoker diagnosed w/Stage IV NSCLC Adenocarcinoma 10/20/09 Completed 6 carbo/alimta followed by 10 Alimta maintenance. Biopsy of iliac negative for metastatic disease. Might not have been a stage IV after all. Oct. 2010, on to surgery…. removed lung. All lymph nodes clear 11-17-10. July 2014 Still all clear. One more 6 month check and if all is good annual only.

August 22, 2013 at 4:56 pm  #1258737    

flovesee

OMG you are right. I guess I have not met that out of pocket maximum before, but it looks like I am only a couple hundred away. Thank you!. I will call insurance tomorrow. As for the Alimta cost, that is easy to find, just look up Alimta prescription. I have found Neulasta, Avastin, all of them. My Alimta is also given in a drip at the cancer center, along with a anti nausea and a b12 shot. It is a good thing I look things up, my doctor actually forgot to give me ANY folic acid, before my first Alimta dose, during, or after. I found out I was supposed to have it and called them (!). Needless to say my first week was not fun.

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