Why is Genentech covering 80% cost of Herceptin?

[Emelie B]

I am wondering if anyone has an explanation for the sudden generosity of Genentech? I went in for my 1st treatment of the year, and was asked to visit with the financial advisor. I was told that since I am on Herceptin, no matter my household income (really?) I qualify for them to pay 80% of the drug to offset my deductible. OK?
I asked her why and said she did not know.
I should be receiving a call from them to authorize this and was wondering if anyone finds this very magnanamous of them.
Does this have anything to do with the delay for FDA approval of TDM-1?
Just my thougts. If anyone out there has any further info. would appreciate sharing.
Hope everyone had a nice holiday season and is planning for the new year,
Emelie

[schoolteacher]

I understand the income limit to be $100, 000.00 and the total amount to receive to be $2000.00 dollars. I am going to ask my doctor about it tomorrow. The $2000.00 would help with my dedcutible and out-of-pocket which consists of $3800.00. I sure hope to receive this.

Amelia

[oregon]

Hi everyone!

I am almost done with Herceptin and was offered the same when I went to my first infusion. I was so taken back by what the financial counselor was saying, I told her I needed to think about it. Glad someone brought this up. From my what I understand the limits to be are consistent to what Amelia stated. Does that mean we can apply the amount Genetech picks up to our deductible? What is TDM-1?

Terri
(Oregon)

[Pmoore]

I just filled out the paper work today for the assistance .I was wondering the same thing but I'm not complaining.
Pia

[anna4969]

Wow!! I am very interested in this as I have a $8000 out of pocket amount. What I did notice was that last year the cost of my Herceptin was close to $10,000 per infusion and Jan. 2nds was $7,000. So maybe they have cut the cost, still my insurance company, after the negotiated price will pay $4600. That is once I have met the $8000 out of pocket. I am wondering,too, can this be applied to deductibles in some way?

Thanks so much for this post. I checked with Genentech, and it will cover 80% of your deductible/co-pay for Herceptin up to $4,000 a year ($1,500 a year if your household income is over $100,000). You must have private insurance (not Medicare or Medical) and be treated in the US. (There are two states that are excluded, but I don't remember which ones.) I will try to post the link to the relevant website later today. The application process seems to be very easy.

[sarah]

$7000 and 10,000 an infusion!!! Here is France it costs 2200 euro ($2,832) and naturally is covered 100% by the universal health coverage. obviously those American hospitals have not bargained well. I am shocked and saddened - it's means some won't be able to afford it.

[Nancy L]

I talked to them today and the co-pay card doesn't apply to Medicare but I was told there is help available for Medicare patients depending on the type of insurance you have. You just need to have your doc fill out the forms they can download from this site and fill them in for you. Then Genentech will try to assist in getting you help if applicable.



Herceptin® Access Solutions®

Herceptin® Access Solutions® helps to resolve specific access and reimbursement issues for individual patients every day. Our dedicated Specialists help bring patient treatment and practice solutions together.
Our staff can help:

• Resolve benefits and coverage issues
• Find co-pay assistance for underinsured patients
• Provide free medicine for uninsured patients through the Genentech® Access to Care Foundation
• Individualize services to meet patients' specific needs

To speak live with one of our Specialists, call 1-888-249-4918 (weekdays 6AM-5PM PST), or fax 1-888-249-4919
Learn more at www.HerceptinAccessSolutions.com ›

[DeenaH]

Do you apply through your doctor or genentech directly? My annual infusion deductible is $1500, so this would help a lot.

[Nancy L]

They told me your doc must fill and fax in the forms.

[anna4969]

Gosh, thank you everyone!!! I will call on Monday and see what can be done if anything.

And Yes, Sarah, I am not kidding on that cost. In fact, last year, I had 6 infusions at MD Anderson, the renowned cancer center, and with Herceptin, access to my port and sodium chloride(saline solution), each infusion was very close to $12,000. Unbelievable, I know.

I agree, sad, sad. I thank the dear Lord every single night for the insurance we do have, even if I have to meet this $8000 out of pocket before insurance will pay 100%. And as you can see about after about one treatment, I am there. January brings me much stress.

Be well everyone

[CoolBreeze]

Wow, my insurance covers 100 percent of everything <knock wood> That includes all my chemos, herceptin, my hospitalizations, my liver resection. I didn't have cancer when I chose this insurance but I'm glad I selected so well. I'm not sure I could afford treatment if I had to pay for it. I'm sorry for those of you who do and I'm really glad herceptin is helping! Whatever the reason!

Below is further information about enrolling in Genentech's program to receive help with co-pays. I just enrolled, and it was very easy. Basically, if you go to the website (CoPayAssistanceNow.com) and you will find the form that you need to fill out and give your oncologist. (Very short form.) There is another form that the oncologist must fill out and fax to Genentech (also very short). Your date of enrollment is the date Genentech receives the form from your oncologist, although it will take some additional time for them to process the request. As mentioned above Genentech pays 80% of your Herceptin co-pays or deductibles up to $1,500 a year if your household income is above $100,000 and $4,000 if it is less.

From Genentech's website:

What is the Genentech BioOncology Co-pay Card?
Are you worried about how you are going to pay for your Herceptin® (trastuzumab) co-pays or out-of-pocket costs? We offer the Genentech BioOncology Co-pay Card to help you.
Have you told your doctor's office you are concerned about paying for your Herceptin co-pay? If you qualify for the card, you could have access to up to $1500 or $4000 per year to help. How much help you can get depends on your yearly income.
You can apply for the Genentech BioOncology Co-pay Card by:
Applying online at CoPayAssistanceNow.com
Calling 855-MYCOPAY
Contacting your specialty pharmacy (SP)
Contacting your doctor's office
If you get a Genentech BioOncology Co-pay Card, it may be used only to help with your co-pay for Herceptin. You can use the card for up to $4000 or $1500 per year. You should let your SP know if you get a Genentech BioOncology Co-pay Card.
If your yearly household income is more than $100,000, you could have access to up to $1500. If it is $100,000 or less and you need more help, you could get up to $4000. You will be asked whether you make more or less than $100,000. Please be sure to report this correctly. You may have to submit financial records later.
So how do you get started? You need to qualify. Here are the rules to get a card:
You have a health care plan not run by the government
You live in the United States or Puerto Rico
You are 18 years of age or older
You are NOT eligible for the Genentech BioOncology Co-pay Card if:
You have Medicare Part D, Medicaid, Medigap or TRICARE (or any other federal or state benefit program)
You do not have a health care plan
You live or receive treatment in Massachusetts or Vermont (because the states do not allow this plan)
You get help from the Genentech® Access to Care Foundation
To get started, you must first enroll by visiting CoPayAssistanceNow.com or calling 855-MYCOPAY. A Herceptin Access Solutions Specialist then helps you in the enrollment process. If you qualify for the card, you and your doctor's office are sent a welcome letter.
Once you are in the program, you pay only 20% of your co-pay. The program pays the other 80%. This goes up to a limit of $1500 or $4000 per year. Once the maximum amount is used up for the year, you pay any balance left over.
For example, if your Herceptin co-pay is $500 per month, you pay $100. After the amount on the co-pay card is used up, you must pay for any other costs during that year.
If you have questions, you can call 855-MYCOPAY.

[anna4969]

Thank you!!!! You have done all the leg work and I appreciate that. I will be calling them on Monday. Hopefully get signed up before my next Herceptin on Jan. 23. That would be wonderful. I will hope that forms can be faxed as that would really speed things up.

Again, I/We very much appreciate all your research and information. ))

[schoolteacher]

I filled the forms out yesterday. Sure do hope to get this.

Amelia

[schoolteacher]

Genentech called, and I have been approved. This will include yesterday's treatment.

Amelia