Its The Herceptin Price is Right Game Again

Sheila · 09-21-2009, 02:21 PM

Several years ago, I wrote in to get a feel about how much different areas of the country were charging for Herceptin. The difference was huge. Although i go to a PPO hospital, the Herceptin price is more than anywhere around. last time, i filed a complaint with the Illinois Attny. General, they looked into it, and the hospital dropped the price and even back paid insurances, private payees etc. Well, just got my bill again, and it seems they are back up in the price...I get mine every 2 weeks to coincide with chemo. The price is $15,000....so if you could, let me know what your facility charges for Herceptin, and what part of the country.... I am going to file a complaint again I think!

Chelee · 09-21-2009, 05:26 PM

Shelia, All I can say is that's HIGH! My gosh...I know it's been a while since I've had Herceptin...but I am pretty darned sure my insurance was billed $3000 (something) every infusion. I will have to dig up the the bill to find the exact amount for you.

I have to say I am impressed with the way you contacted the Attorney General...you GO GIRL. Another complaint does sound in order. (It's been 3 yrs since I had Herceptin...maybe prices have went way up?) Can't wait to see what others are charged. (Like your new picture...love the hair.)

Chelee

Patty F · 09-21-2009, 06:48 PM

My last treatment in Northwest Indiana was January 29, 2009. The charge was 8275.00. That included all charges. The actual Herceptin charge was 7500.00

Laurel · 09-21-2009, 06:58 PM

My last few infusions were just over $11,000 all inclusive.

alicem · 09-21-2009, 09:57 PM

My herceptin costs have been consistent. The medication is broken out separate from the office visit and other misc. small charges. I believe I get 6 mg. of Herceptin every 3 weeks. The charges submitted are $7,473 and the charges at Aetna's agreed pricing (and thus paid by the plan) are $2,953.

I live in Austin, Texas. I hope this helps. By the way Sheila, I love your new picture!!!

Alice

Colleen007 · 09-23-2009, 06:20 AM

I get treatment just outside of Boston and have an HMO. I get Herceptin every 3 weeks and the last 2 charges for the Herceptin alone (not counting the doctor visit and all the other small charges that go with each visit) were $4,750...with the insurance covering $3,297.50. If you need any further info for your complaint to the AG, feel free to send me a private message and I'd be happy to give you more details.

If a person had insurance with a 20% co-pay, there is a HUGE difference in what they'd have to pay if the cost was $15K in your area vs. under $5K in my area.

Colleen

Rich66 · 09-24-2009, 10:33 AM

The variation in pricing is amazing. but not surprising considering how little transparency there is in an arena where insurance often blocks a clear view. On a micro scale, I had a minor mouth irritation that a doc precribed a generic lidocaine solution for. They wanted to fax it to the pharmacy of my choice but since I apy out of pocket, I asked for a generic script and shoppped around. A few phone calls revealed I could pay up to 4x the cost of the lowest available price. This happens most of the time I need something and shop around. I have never seen an over the counter medication range to such multiples, presumably because people are aware what it should cost. There are also instances where a long term medication can be significantly less expensive if a larger amount is purchased. Pharmacists aren't likely to mention this unless asked.
In the cancer treatment arena, I wonder if variances in cost end up influencing treatment decisions at the doctor or patient level. If someone is going to get multiple rounds of Herceptin, could a case of it (or contract) be purchased at a discount? I just posted an article about perversions in the coverage of oral vs IV therapies:
http://her2support.org/vbulletin/showthread.php?t=41199

Whether within private or government health care coverage, hidden cost perversions can lead to invisible rationing...not so invisible when a copay makes you think twice.

Brenda S · 09-24-2009, 11:15 AM

I live in SW Indiana. The amount paid to Anthem, our insurance carrier, is approximately $2800 per infusion. This includes the herceptin, saline, "tray" etc. The cost variance is astounding.

Jackie07 · 09-24-2009, 01:27 PM

When I had my treatment in 2004, my 3-week TCH expense was $25,000, including all labs and other necessary fees (such as shots to increase the white blood cells). I think the Herceptin part was $7,000.00. 18 weeks later when it became just weekly Herceptin, I think the cost of the medicine was $3,500.

When I got a new job in the fall of 2004, my new insurance didn't start until October 1. And my old insurance through COBRA did not want to pay for the October cost since we had stopped paying the premium - the two parties sent bills back and forth and eventually the new insurance paid for it (about $40,000 just for the October expense.) I always wondered if it had anything to do with my teaching contract not getting renewed.

(Now that the neuropsychologist had determined that my cognitive function had been declining, I feel much better about my 'underperformance' last year and am glad that 'discrimination' was not the major reason behind it. Long time ago, I had coined a phrase to describe myself - 'a disabled foreign born female minority'. I have never obtained a job because of 'quota', but I have never kept a job after a major medical procedure, either.)

Jaimieh · 09-24-2009, 07:08 PM

My herceptin treatments are $4200 (rough estimate) and it went down $2000 for some reason. I would be complaining...

tricia keegan · 09-26-2009, 04:02 PM

Sheila that is so high!!!

I was told herceptin was expensive but because we have national health insurance it did'nt cost me anything of course.
Just for the record I was told it was in the region of $15,000 here per infusion!!!

Chelee · 09-26-2009, 04:19 PM

Like I already mentioned...the 1st time around mine was a bit over $3000 per infusion of Herceptin. I will be starting Herceptin Monday and will see what they are charging now? It's probably gone up since last time...but I can sure betcha it's not close to $15000. Wow...that's expensive.

I would be very concerned about the cost influencing trt decisions like Rich mentioned already. And that should never be a deciding factor.

Chelee

DanaRT · 09-26-2009, 05:47 PM

Sheila,

I tried to find my old statements but have been unsuccessful. I do know that the entire TCH treatment was around $17,000 per session. Neulasta was $6,800. in the ER because it was always on a Saturday. I will keep looking.

I do have record that it was 462 mg of Herceptin over 90 minutes long every three weeks. Not that this helps. But mg may have something to do with price difference.

See you soon!

Dana

sarah · 09-27-2009, 07:12 AM

$15,000 for just the Herceptin??? sounds extremely high.
Here in France it costs 2,200 euro which of course is 100% paid by the universal health plan, so no co-pay by me. It's administered in the top hospital in Mougins by specially trained chemo nurses with a chemo doc on hand at all times and a pain doc and psychologist on call.
sarah