Herceptin Cost

Hello Everyone,
Yesterday I got the results of my bc pathology re-testing, which was a FISH test. Fish positive for Her2. I had a 2cm bc tumor er/pr- Her2 3+ high grade, with no lymph node involvement, had a lumpectomy last September. 6 Taxol treatments completed in February. My onc wants to start me on Herceptin now. She told me the drug could cost up to approximately $80,000 for a year. I would be responsible for 20% of that. My point is, and I'm not sure if it is because I am totally overwelmed after all the treatments or just plain whinny, do I really need Herceptin. Granted, I am Her2+ but I had no lymph involvement, clean margins after surgery (they were close, but clean). It seems to me that it is a large expense to put my family though for something that MAY help for something I may get again.

Nancy,

From what I understand about Herceptin, it would help to reduce the risk or reoccurance. I understand your reservations about the cost, but would you be able to claim any of the 20% on your income tax, thus reducing the actual cost to you? I am sure that your family thinks that you are worth the cost. It is frightening to think that you might put that amount money out on something that is not guaranteed but you have to believe that you are worth the cost. I'm sure you wouldn't hesitate it if were one of your family members in the same position. I'm sorry that I can't offer you any advice regarding the cost not covered by insurance, I hope that others can. Good luck and best wishes.

Joan

Nancy
I would agree that you would probably benifit from Herceptin. I don't know where you live, but it seems that the price of Herceptin varies wildly. You would do well to check around and see what other oncologists in your area charge. One woman posted that you could enjoy a trip to Orlando, Florida for your treatments and still save lots of money based on what other oncologists even in the same area charge! My impression is that you could save almost 1/2 the cost. It wouldn't help to look and make some calls. Let us know what you find. My insurance has not all cleared but it appears the Herceptin would be about $50,000 a year for weekly treatments.
Janet

Nancy R
I don't want to scare you but I was Her2 3+, node neg, 0.7cm tumor, L mastectomy and Herceptin for Stage 1 was not offered 3 years ago, I ended up with a recurrence 1 1/2 yr. later.........so take it if you have the chance and look to Genentech for financial assistance.
hugs
Sheila

Many medical insurance policies have a maximum annual out of pocket amount.
It can range from $500 to $5,000. You may want to check with your insurance company.

Regards
Joe

Nancy,

I am a little confused, was the HER2 test on the tumor from last September. The below discussion is assuming that the HER 2 test is from the original tumor and not a reoccurance.

I don't want to scare you but I have done a lot of research in the last two weeks. Keep in mind that these are just statistics and a lot more goes into survival, like attitude etc.

One item I found was that there is a 20% chance that your cancer has already spread if you caught is in stage one with no positive nodes. The problem is that current medical techniques can not detect it. In our case, there is above a 90% chance it has already spread (we are at least stage III when discovered). We find out the test results tomorrow if it has spread (detectable spread) which would put us in stage IV.

The chance of 5 year survival is about 45% on herceptin based treatment for advanced stage cancers. I haven't sceen a lot of data on early stage cancers but it should be significantly higher.

My sister had a 2 cm BC tumor last year and decided not to have chemo. Not for financial reasons but for quality of life reasons. She feals confident that it didn't spread and the odds are in her favor.

I guess the only one that can answer your question is you. How confident are you that it hasn't spread and you are clear. Deep down you probably know the answer and you should go with it. If you decide that Herceptin is for you then I am sure that the financial aspects of that option will be worked out. (Most insurances have a max copay when you have an 80% plan) Typically it is 5000 but plans vary.

As for our case, we haven't even tought of the cost when looking at treatment options. As for me, I would rather be broke and have my wife alive, than rich and a widower. We will worry about the money later. If that is our biggest worry, then we have come out of this in great shape.

Good luck,

Shaeff

Thanks to all who have responded. Thank you especially to Shaeff, your answer was very heart felt, and good luck to you tomorrow getting your results. I hope everything comes back way better than you expected. There's always room for one more miracle, right?

My original cancer last September was Her2+ but was not tested using the FISH method. Therefore, the FISH test was just completed using the original tissue tumor, making sure I was qualified to receive Herceptin. I guess, like you said, deep down inside I know what I have to do, but for the last few days I have been very down and pretty much fed up with all of this. What a big Whiner, huh? Instead of being thankful I only have a very small treatable problem, I am focusing on the cost of all of this. Especially after paying $5000 per Neulasta injection (6 in all) and the 6 chemo treatments, surgery, etc. The cost is probably not even the reason for me being so down, it's just something to zero in on. Does anyone else get like this, or am I just being a drama queen? Maybe it's the phase of the moon getting to me. Perhaps I should go outside and bark at the moon, I'd probably feel better. I really need to "cowboy-up", stop being such a grumbler and get on with my life. From reading the boards in here, 99% of you seem so happy-go-lucky, your spirts are high, and still, you are fighting the worst monster of you life. How do you do it?

Well, sorry to be so long winded, I really needed to vent.

Blessings, Love, Luck and happiness to all of you!
Nancy

Something that no one has mentioned (I think) is the possibility your Onc. could put the amount your treatments cost on payments. I had a talk with the person who does the billing at my Onc's office because I was stressing out over the amount of medical expenses I was running up and she said that whatever was "do-able" for me was OK. They just wanted to see "something" each month. She said there was one person there that was paying $50 a month. She stressed that their policy was never to send accts. to Collections. Now, you can't walk away from your large medical bill, what will probably happen is it will come out of your estate when your estate is settled (at least this is what I understand). I talked to my kids and told them that I was sorry that I wouldn't be able to leave them very much from my estate because of the cost of the herceptin treatment and they said they would much rather have me around as long as possible than any amount of money...bless their hearts. I'm sure your family feels the same way. Of course, every Oncologist Office is different but you might give yours a try and see if they can put your herceptin costs on payments for you. Best of Luck, Linda in Calif.

Nnacy writes:
>>Especially after paying $5000 per Neulasta injection (6 in all)

I don't know where you live, but Neualsta sure doesn't cost that much here in southern Florida! Walgreens charges $3200 for it and Costco $2,800. Blue Cross pays about $2,300 and that is the amount my doctor's office will accept. Walgreens and Costco would have accepted that amount, also.
If you missed my post on Neulasta, I had worried whether or not BC would allow payment in a doctor's offic or if I had to get it from a pharmamcy. Found out I could get it either way. I had the doctor's office inject, but it was easy to do it if I had wanted to do it myself. I just did find out that my insurance will only pay for two shots a month. If I need more, then Costco is the cheaper place to get it.

I sometimes feel like I am at a mall looking for bargins, But the qualitly of care is the same, just the prices. Janet

I live in south Texas. Getting the Neulasta injection any where other that in the onc's office was not an option. I even offered to give the injection to myself at home (I'm a nurse) just to same myself the 40 minutes travel time to her office the day after chemo when I wasn't feeling well. That was a big no! So, comparing prices was out for me.
Thanks for your help though, maybe I should just look for another doctor that is willing to work with their patients instead of concentrating on the bottom line - co-pay.
Nancy

Nancy writes:
I live in south Texas. Getting the Neulasta injection any where other that in the onc's office was not an option. I even offered to give the injection to myself at home (I'm a nurse) just to same myself the 40 minutes travel time to her office the day after chemo when I wasn't feeling well. That was a big no! So, comparing prices was out for me.

Janet replies:
Nany that is really terrible! Although one onc wouldn't give me a shot in his office and said it was because my insurance wouldn't cover it, (I guess it maybe meant that it wouldn't cover his inflated price?) I was allowed to self inject. I changed oncs so did not have to. And I am not a nurse.

What was done would seem to be boarderline illegal and cetainly not ethical to take advantage of a person with cancer. Do they count on us not reporting this because we have cancer? This is probably not a suitable topic for this list. But hopefully a warning that as well as shopping for the best oncologist, one might also also check his/her rates.
Janet

Janet,

I posted before about the charging for my neulast shots, and it had nothing to do with the oncologist office. I was all the insurance company. If I got my shot at the pharmacy, it would be charged as a prescription drug. My policy has a $3000 annual cap on prescriptions, so after one shot I would pretty much max out my prescription benefit and be paying for neulasta myself. If however, I had the shot done at the onc's office, it was considered as part of treatment, just like chemo, and filed under the medical benefit. I had to pay nothing because I had already met my total out of pocket expense of $2000 annually. This is clearly a case where the insurance company felt they were setting policy in their best interest, but did work in the case. It works to the benefit of the patient.

Nancy,

Please do check to see if you have an annual maximum out of pocket expense. The 20% co-pay is pretty standard, but usually only up to a certain point. When you reach you annual out of pocket maximum, you don't have to pay any more that year. Mine is BC/BS t $2000 and I got there quickly.

Always check with your insurance agent, call the company direct, or speak with you HR person a work if it seems insurance may be a problem. Your medical facility should have someone that could help, but smaller clinics not
know how best to deal with your particular company. Be your own advocate. Insurance is a benefit for you--find out all you can, don't accept the first answer, keep looking till you get the best answer for your situation.

Sassy

Hi Nancy-

I don't know if you are covered by insurance...

I too had difficulty obtaining the Herceptin before the ASCO conference. Now, I have it and my insurance covers it (I'm Stage I).

Anyway, my onc in Orlando FL charges just under $2000 per infusion for the "every 3 week protocol". This is what he charges the insurance company. His office staff told me that they would charge $1500 for the non-insured.

Maria

Definitely TAKE THE HERCEPTIN...but try to keep costs to a bare minimum (I'm a struggling self-employed single mom with the disease with no help from either social security, medicare, or my ex..so yes, the money is a grave concern for me.) The oncology office bills about $7,000 per each 6mg/kg (I weigh nearly 200 lbs so I have to take quite a high dose...289 I think). The insurance settles with the onc office for a little over $3,000. Yet another incentive for ME TO LOSE WEIGHT..ha ha ha haaaaa, but I am also nearly 5 foot 10, so it is not horrible..just expensive...

I know it is not common place, yet, but you can use your own tumor markers as biofeedback to chart how much Herceptin you need and how frequently to take it with great benefit and at a fair price. Tell your onc to follow the Diabetic insulin model. Right now I am doing 6mg/kg every 6 weeks...this totals to only 8 or 9 doses a year, and costs less than $30G
Plus, there are many things you can also do like careful diet, certain supplements, walking, etc. that can keep you generally healthy so your OTHER medical expenses stay low. But no matter what the cost, GET TO THE HERCEPTIN as quickly as you can and find out as soon as you can exactly where your CA 27/29 and serum Her-2 markers are...not to be a doomsayer..but by now, given the time that has elapsed...it could already be raising its ugly head. This illness is something YOU REALLY have to stay on top of to survive, but you can "LIVE THE DREAM" I am still here, 8 years out, 6 with mets and use HERCEPTIN ALONE. Good luck to you, Gina.

If your provider of the herceptin is a preferred provider, would you not then pay 20% of what the insurer alloowed, not 20% of the retail cost? I am not sure what type of insurance you have.