› Forums › General Melanoma Community › Ipilimumab Costs – What Happened?
- This topic has 33 replies, 6 voices, and was last updated 11 years, 1 month ago by
becky62.
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- May 6, 2014 at 6:05 pm
In 2011 and 2012 the estimated cost per infusion was $ 30,000. We just received our bill and it was $ 98,000 for the first treatment. How can the cost increase if the product is becoming widely used? I thought it was expensive enough at 30k, can't see how we are going to manage 98k. We are applying for assistance through the Yervoy website, but at most they will supplement the cost by a maximum of $25k.
Has anyone experienced similar sticker shock, and is there any recourse / resourse available that others have found to help with the costs?
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- May 6, 2014 at 11:42 pm
when I had IPI in 2011, the medical center billed the insurance for something in the ballpark of $350k (forget the exact amount) for 4 infusions. My insurance company "negotiated" that down to $72k for the 4 infusions.
I surmise you are getting charged the so-called "rack rate", i.e. there have been stories on 60 Minutes and elsewhere about hospitals having a super-high list price, knowing the insurers are never going to pay anywhere near that. But the self-payers get a bill that is multiples of what it should be. There probably should be a way to work with the hospital to confront them about the "rack rate" and ask to be charged the reasonable cost of reimbursement. I don't have experience with this but I think I heard it can be done from the news stories I heard about.
Same for scans and other things — looking at my statements, the insurers pay a fraction of the "rack rate" the hospital bills for initially.
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- May 6, 2014 at 11:42 pm
when I had IPI in 2011, the medical center billed the insurance for something in the ballpark of $350k (forget the exact amount) for 4 infusions. My insurance company "negotiated" that down to $72k for the 4 infusions.
I surmise you are getting charged the so-called "rack rate", i.e. there have been stories on 60 Minutes and elsewhere about hospitals having a super-high list price, knowing the insurers are never going to pay anywhere near that. But the self-payers get a bill that is multiples of what it should be. There probably should be a way to work with the hospital to confront them about the "rack rate" and ask to be charged the reasonable cost of reimbursement. I don't have experience with this but I think I heard it can be done from the news stories I heard about.
Same for scans and other things — looking at my statements, the insurers pay a fraction of the "rack rate" the hospital bills for initially.
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- May 6, 2014 at 11:42 pm
when I had IPI in 2011, the medical center billed the insurance for something in the ballpark of $350k (forget the exact amount) for 4 infusions. My insurance company "negotiated" that down to $72k for the 4 infusions.
I surmise you are getting charged the so-called "rack rate", i.e. there have been stories on 60 Minutes and elsewhere about hospitals having a super-high list price, knowing the insurers are never going to pay anywhere near that. But the self-payers get a bill that is multiples of what it should be. There probably should be a way to work with the hospital to confront them about the "rack rate" and ask to be charged the reasonable cost of reimbursement. I don't have experience with this but I think I heard it can be done from the news stories I heard about.
Same for scans and other things — looking at my statements, the insurers pay a fraction of the "rack rate" the hospital bills for initially.
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- May 6, 2014 at 11:43 pm
And like you say, the price BMS said it was going to charge for Yervoy was $120k for 4 infusions, so I was startled when I saw what my facility billed the insurance comapny for.
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- May 7, 2014 at 3:13 pm
Yes,
I just finished my 4th treatment and still waiting for insurance to pay for the first.
My expectation was the $120,000 for the 4 infustions and was shocked to see the first bill to insurance for $84,000!
I figured the insurance would get that price way down at thier negotiated price. I know at the hospital it is posted that private pay automatically gets 25% price reduction on anything.
I am on a clinical trial which does NOT include the cost of the IPI which I didn't totally understand and insurance is balking paying it at this point because it IS a clinical trial. They would pay if it it was IPI alone but the fact that it is being used in tandem with another drug it then is NOT FDA approved.
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- May 7, 2014 at 3:13 pm
Yes,
I just finished my 4th treatment and still waiting for insurance to pay for the first.
My expectation was the $120,000 for the 4 infustions and was shocked to see the first bill to insurance for $84,000!
I figured the insurance would get that price way down at thier negotiated price. I know at the hospital it is posted that private pay automatically gets 25% price reduction on anything.
I am on a clinical trial which does NOT include the cost of the IPI which I didn't totally understand and insurance is balking paying it at this point because it IS a clinical trial. They would pay if it it was IPI alone but the fact that it is being used in tandem with another drug it then is NOT FDA approved.
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- May 7, 2014 at 5:25 pm
Cpeters,
Check the Healthcare.gov website!!! The affordable care act makes it illegal for insurance companies to deny coverage for clinical trials!! It says in part:
- Ensuring Coverage for Individuals Participating in Clinical Trials. Insurers will be prohibited from dropping or limiting coverage because an individual chooses to participate in a clinical trial. Applies to all clinical trials that treat cancer or other life-threatening diseases. Effective January 1, 2014.
Stand up for your rights, even though I know it is hard. Hope this helps! Wishing you my best. Celeste
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- May 7, 2014 at 5:25 pm
Cpeters,
Check the Healthcare.gov website!!! The affordable care act makes it illegal for insurance companies to deny coverage for clinical trials!! It says in part:
- Ensuring Coverage for Individuals Participating in Clinical Trials. Insurers will be prohibited from dropping or limiting coverage because an individual chooses to participate in a clinical trial. Applies to all clinical trials that treat cancer or other life-threatening diseases. Effective January 1, 2014.
Stand up for your rights, even though I know it is hard. Hope this helps! Wishing you my best. Celeste
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- May 7, 2014 at 7:21 pm
Thanks for the reply, Celeste…I was looking for it again but unfortunately there are small differences from state to state. For Missouri I is for a Phase 2 or above clinical trial…..I am in a phase 1.
We are going thru all of the appealment processes and my employer is helping with that and helping me.
I am lucky that our insurance is self funded and they are trying to work something out but the language is phase 2 or above for Missouri.
Charlie
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- May 7, 2014 at 7:21 pm
Thanks for the reply, Celeste…I was looking for it again but unfortunately there are small differences from state to state. For Missouri I is for a Phase 2 or above clinical trial…..I am in a phase 1.
We are going thru all of the appealment processes and my employer is helping with that and helping me.
I am lucky that our insurance is self funded and they are trying to work something out but the language is phase 2 or above for Missouri.
Charlie
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- May 7, 2014 at 7:21 pm
Thanks for the reply, Celeste…I was looking for it again but unfortunately there are small differences from state to state. For Missouri I is for a Phase 2 or above clinical trial…..I am in a phase 1.
We are going thru all of the appealment processes and my employer is helping with that and helping me.
I am lucky that our insurance is self funded and they are trying to work something out but the language is phase 2 or above for Missouri.
Charlie
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- May 7, 2014 at 5:25 pm
Cpeters,
Check the Healthcare.gov website!!! The affordable care act makes it illegal for insurance companies to deny coverage for clinical trials!! It says in part:
- Ensuring Coverage for Individuals Participating in Clinical Trials. Insurers will be prohibited from dropping or limiting coverage because an individual chooses to participate in a clinical trial. Applies to all clinical trials that treat cancer or other life-threatening diseases. Effective January 1, 2014.
Stand up for your rights, even though I know it is hard. Hope this helps! Wishing you my best. Celeste
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- May 7, 2014 at 3:13 pm
Yes,
I just finished my 4th treatment and still waiting for insurance to pay for the first.
My expectation was the $120,000 for the 4 infustions and was shocked to see the first bill to insurance for $84,000!
I figured the insurance would get that price way down at thier negotiated price. I know at the hospital it is posted that private pay automatically gets 25% price reduction on anything.
I am on a clinical trial which does NOT include the cost of the IPI which I didn't totally understand and insurance is balking paying it at this point because it IS a clinical trial. They would pay if it it was IPI alone but the fact that it is being used in tandem with another drug it then is NOT FDA approved.
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- May 7, 2014 at 8:48 pm
There is a difference between the cost of the drug (in this case, Yervoy) and the cost of the treatment. BMS started out charging $30,000/infusion for Yervoy; they may stil be charging that. But the bill for $98,000 comes from the hosptial. This covers not only the $30,000 for the Yervoy itself but also all the doctors and nurses and pharmacists involved with the procedure, the lab tests before and after each infusion, the discharge paperwork and medicaitons, etc. etc.
This is just more of the same old "$50 for a Bandaid" billing that we Americans have been dealing with for decades. Doesn't mean that BMS increased the cost of the Yervoy.
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- May 7, 2014 at 8:48 pm
There is a difference between the cost of the drug (in this case, Yervoy) and the cost of the treatment. BMS started out charging $30,000/infusion for Yervoy; they may stil be charging that. But the bill for $98,000 comes from the hosptial. This covers not only the $30,000 for the Yervoy itself but also all the doctors and nurses and pharmacists involved with the procedure, the lab tests before and after each infusion, the discharge paperwork and medicaitons, etc. etc.
This is just more of the same old "$50 for a Bandaid" billing that we Americans have been dealing with for decades. Doesn't mean that BMS increased the cost of the Yervoy.
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- May 7, 2014 at 8:48 pm
There is a difference between the cost of the drug (in this case, Yervoy) and the cost of the treatment. BMS started out charging $30,000/infusion for Yervoy; they may stil be charging that. But the bill for $98,000 comes from the hosptial. This covers not only the $30,000 for the Yervoy itself but also all the doctors and nurses and pharmacists involved with the procedure, the lab tests before and after each infusion, the discharge paperwork and medicaitons, etc. etc.
This is just more of the same old "$50 for a Bandaid" billing that we Americans have been dealing with for decades. Doesn't mean that BMS increased the cost of the Yervoy.
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- May 8, 2014 at 4:52 am
The insurance companies wouldn't pay $68k for the non-drug hospital part of a single 1-day outpatient infusion, which amounts to about 2 hours in an infusion room for the patient. Nor do they likely pay the full $30k per infusion for the Yervoy. For me, the hospital was reimbursed 18k total per infusion, Yervoy and hospital costs combined.
The hospital part is, AFAIK:
– a nurse to weigh you and install an IV
– the pharmacy that likely does a relatively simple procedure (i.e. no compouding) to get the IV bag ready with the right amount of Yervoy mg/kg
– the nurse gettting an IV drip going with the Yervoy bag
– the nurse flushing the IV line with saline afterwards, then removing the IV.
For me, doctor visits and labs were billed separately (and again not reimbursed by the insurance company for anything that seemed usurious — although for self-payers it would probably be billed about 500% higher).
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- May 8, 2014 at 4:52 am
The insurance companies wouldn't pay $68k for the non-drug hospital part of a single 1-day outpatient infusion, which amounts to about 2 hours in an infusion room for the patient. Nor do they likely pay the full $30k per infusion for the Yervoy. For me, the hospital was reimbursed 18k total per infusion, Yervoy and hospital costs combined.
The hospital part is, AFAIK:
– a nurse to weigh you and install an IV
– the pharmacy that likely does a relatively simple procedure (i.e. no compouding) to get the IV bag ready with the right amount of Yervoy mg/kg
– the nurse gettting an IV drip going with the Yervoy bag
– the nurse flushing the IV line with saline afterwards, then removing the IV.
For me, doctor visits and labs were billed separately (and again not reimbursed by the insurance company for anything that seemed usurious — although for self-payers it would probably be billed about 500% higher).
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- May 8, 2014 at 4:52 am
The insurance companies wouldn't pay $68k for the non-drug hospital part of a single 1-day outpatient infusion, which amounts to about 2 hours in an infusion room for the patient. Nor do they likely pay the full $30k per infusion for the Yervoy. For me, the hospital was reimbursed 18k total per infusion, Yervoy and hospital costs combined.
The hospital part is, AFAIK:
– a nurse to weigh you and install an IV
– the pharmacy that likely does a relatively simple procedure (i.e. no compouding) to get the IV bag ready with the right amount of Yervoy mg/kg
– the nurse gettting an IV drip going with the Yervoy bag
– the nurse flushing the IV line with saline afterwards, then removing the IV.
For me, doctor visits and labs were billed separately (and again not reimbursed by the insurance company for anything that seemed usurious — although for self-payers it would probably be billed about 500% higher).
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- May 8, 2014 at 2:58 am
Global spending on cancer drugs alone rose 28 percent to $91 billion in 2013 from $71 billion in 2008, according to a report by the IMS Institute for Healthcare Informatics, the group that also reported the monthly cost rise.
Those findings support a Bloomberg review of drug prices reported on May 1 that found dozens of medicines for ailments ranging from cancer to multiple sclerosis, diabetes and high cholesterol have doubled or more in price since late 2007. The Bloomberg review used data supplied by DRX, a Los Angeles-based company that provides drug comparison information.
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- May 8, 2014 at 2:58 am
Global spending on cancer drugs alone rose 28 percent to $91 billion in 2013 from $71 billion in 2008, according to a report by the IMS Institute for Healthcare Informatics, the group that also reported the monthly cost rise.
Those findings support a Bloomberg review of drug prices reported on May 1 that found dozens of medicines for ailments ranging from cancer to multiple sclerosis, diabetes and high cholesterol have doubled or more in price since late 2007. The Bloomberg review used data supplied by DRX, a Los Angeles-based company that provides drug comparison information.
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- May 8, 2014 at 2:58 am
Global spending on cancer drugs alone rose 28 percent to $91 billion in 2013 from $71 billion in 2008, according to a report by the IMS Institute for Healthcare Informatics, the group that also reported the monthly cost rise.
Those findings support a Bloomberg review of drug prices reported on May 1 that found dozens of medicines for ailments ranging from cancer to multiple sclerosis, diabetes and high cholesterol have doubled or more in price since late 2007. The Bloomberg review used data supplied by DRX, a Los Angeles-based company that provides drug comparison information.
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- May 8, 2014 at 5:31 am
Reviewed one of my 2011 insurance billing / reimbursement statements for 1 Yervoy infusion (statements for all 4 cycles have the exact same items):
Item: charged by hospital / reimbursed by insurer
1) Prescription Drug: $12 / $4.80
2) "Radiation Therapy": $875 / $565
3) Prescription Drug: $720 / $288
4) Prescription Drug: $21,204 / $8481
5) Prescription Drug: $360 / $144
6) Prescription Drug: $50.040 / $8749.60
Total: $73,211 charged vs. $18,253 actually reimbursed.
Not sure what the "radiation therapy" code is for, this shows up in each Yervoy cycle but was not radiation I was receiving, maybe it's a mis-code of some kind or something I don't understand.
#4 and #6 must be the Yervoy, maybe they needed two "bottles" of it?
Associated doctor visits and labs billed separately.
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- May 8, 2014 at 3:40 pm
My hospital billed my insurance over 200k for one infusion. Yervoy only. My insurance had contracted with hospital to pay them 105k for it. I'm sure the hospital paid less than 30k for the yervoy. I had a limit on my insurance of 250k per year, so I couldn't get the 4th infusion.
The hospital probably made over 250k on my 3 infusions. I don't know why the insurance companies would contract that much over the actual price of the drug. Couldnt find the answer after many phone calls either.
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- May 8, 2014 at 3:40 pm
My hospital billed my insurance over 200k for one infusion. Yervoy only. My insurance had contracted with hospital to pay them 105k for it. I'm sure the hospital paid less than 30k for the yervoy. I had a limit on my insurance of 250k per year, so I couldn't get the 4th infusion.
The hospital probably made over 250k on my 3 infusions. I don't know why the insurance companies would contract that much over the actual price of the drug. Couldnt find the answer after many phone calls either.
-
- May 8, 2014 at 3:40 pm
My hospital billed my insurance over 200k for one infusion. Yervoy only. My insurance had contracted with hospital to pay them 105k for it. I'm sure the hospital paid less than 30k for the yervoy. I had a limit on my insurance of 250k per year, so I couldn't get the 4th infusion.
The hospital probably made over 250k on my 3 infusions. I don't know why the insurance companies would contract that much over the actual price of the drug. Couldnt find the answer after many phone calls either.
-
- May 8, 2014 at 5:31 am
Reviewed one of my 2011 insurance billing / reimbursement statements for 1 Yervoy infusion (statements for all 4 cycles have the exact same items):
Item: charged by hospital / reimbursed by insurer
1) Prescription Drug: $12 / $4.80
2) "Radiation Therapy": $875 / $565
3) Prescription Drug: $720 / $288
4) Prescription Drug: $21,204 / $8481
5) Prescription Drug: $360 / $144
6) Prescription Drug: $50.040 / $8749.60
Total: $73,211 charged vs. $18,253 actually reimbursed.
Not sure what the "radiation therapy" code is for, this shows up in each Yervoy cycle but was not radiation I was receiving, maybe it's a mis-code of some kind or something I don't understand.
#4 and #6 must be the Yervoy, maybe they needed two "bottles" of it?
Associated doctor visits and labs billed separately.
-
- May 8, 2014 at 5:31 am
Reviewed one of my 2011 insurance billing / reimbursement statements for 1 Yervoy infusion (statements for all 4 cycles have the exact same items):
Item: charged by hospital / reimbursed by insurer
1) Prescription Drug: $12 / $4.80
2) "Radiation Therapy": $875 / $565
3) Prescription Drug: $720 / $288
4) Prescription Drug: $21,204 / $8481
5) Prescription Drug: $360 / $144
6) Prescription Drug: $50.040 / $8749.60
Total: $73,211 charged vs. $18,253 actually reimbursed.
Not sure what the "radiation therapy" code is for, this shows up in each Yervoy cycle but was not radiation I was receiving, maybe it's a mis-code of some kind or something I don't understand.
#4 and #6 must be the Yervoy, maybe they needed two "bottles" of it?
Associated doctor visits and labs billed separately.
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