Differences in charges for Remicade

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LuvsScottygirls
New Member


Date Joined Jul 2007
Total Posts : 9
   Posted 2/17/2009 1:26 PM (GMT -6)   
rolleyes    Has anybody checked the actual price of Remicade through the pharmacy where you get your infusions?  I'm researching the cost of Remicade in different areas.
 
I have found a vast difference in charges between my home state of Wyoming and the state of Arizona.
For the exact same mg's of Remicade there is a difference of of $4500.00 compared to $17,910.00, $28,000.00, and between $25,000.00 and $30,000.00.  I find this unbelievable.  It makes no sense.
 
I am going to continue to try to compare pricing.   I have only been looking into the Remicade and not the cost of the facility or nursing staff.  That charge seems to be more stable. 
 
I welcome any information from you.
 
Thanks

Eva Lou
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Date Joined Sep 2006
Total Posts : 3442
   Posted 2/17/2009 2:36 PM (GMT -6)   
while this info may be intersting, it probably won't help you much if you actually need the drug. For a couple reasons- most of us on it, don't pick up the med at the pharmacy- we go to infusion centers, hospitals, or the GI's office to get it administered. They have the drug there, either from their in-house pharmacy, or from their own stock. It's a powder- it's only mixed with saline at the time of administration, so you can't stockpile it like other meds. Plus, most insurance plans require the drug be administered at a participating facility. I've had 2 different insurers while on Remicade, & both treat it differently than another Rx. It doesn't fall under typical prescription plan pricing. Plus, many infusion centers won't let you just show up with a bag of Remicade, & have them mix it up & administer it- a liability, who knows what you actually have in the med bag! So those numbers probably don't accurately reflect what you may wind up paying for an infusion, if it comes to that. You're better off asking your GI how they administer Remicade, & calling the infusion center to find out how they bill it, then check with your insurer as to how much they cover.

diagnosed with UC '02
meds-
Asacol- 8 tabs/day
Remicade-10mgs/kg- since 4/07
Imuran- 150mgs/day
Culturelle
Fiber supplement
 
 
 


Mamas Boys
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Date Joined Oct 2005
Total Posts : 1460
   Posted 2/17/2009 2:42 PM (GMT -6)   
On my insurance plan - Remicade is not considered a prescription drug.  It falls under the category of a chemo treatment - kind of like an outpatient hospital procedure.  I'm covered 80/20 for that and I typically pay about $400-$500 per insfusion out of pocket.  Still expensive but it is keeping me healthy.

Mamas Boys (aka KTM)
Colazal, Azathioprine, Remicade
Culturelle, MultiVitamin, Folic Acid, Viactiv
Status: Remission!!


Eva Lou
Veteran Member


Date Joined Sep 2006
Total Posts : 3442
   Posted 2/17/2009 3:41 PM (GMT -6)   
yeah, same with me- chemo treatment, which is covered in full. Thankfully! My last insurer considered Remicade to be part of the medical plan, not the prescription drug plan, & it too was covered in full. I've been very lucky! I keep waiting for something to happen, & for me to start incurring charges. Which we can't afford! So far, so good!

diagnosed with UC '02
meds-
Asacol- 8 tabs/day
Remicade-10mgs/kg- since 4/07
Imuran- 150mgs/day
Culturelle
Fiber supplement
 
 
 


dodge08
Regular Member


Date Joined Feb 2009
Total Posts : 31
   Posted 2/17/2009 3:57 PM (GMT -6)   
I just looked at my receipt and it is just under $5200.00 per infusion - there is only one pharmacy in my city that carries it so I don't have many options. It is all covered except $200 (paid through my wife's insurance and some from Remifast) the remaining $200 I will start to get back from the province all my deductables go over $1000.
I'm in Ontario, but some provinces pay for the whole medication.
Male 38, diagnoised in 1998, first major flare in November 2008, have had 2 remicade infusions


LuvsScottygirls
New Member


Date Joined Jul 2007
Total Posts : 9
   Posted 2/17/2009 5:17 PM (GMT -6)   

I probably was not clear.  I do receive infusions at a hospital and they do furnish the Remicade.

My point was that in Wyoming the cost of my dosage of Remicade was $4500.00 plus the actual infusion process which made the entire bill a little over $5100.

In Arizona my dosage of Remicade is $17900.00 plus the actual infusion process which made my total bill $18,000.00 plus dollars.

Because of that difference in price I bagan to check with the pharmacys of the hospitals that administer Remicade and found that the Remicade itself is the reason for the outragious prices.  Each hospital has a pharmacy that applies the cost of the drug to the treatment and each hospital bills it out differently.

I do have insurance but I still have the 80/20 situation until I hit the out of pocket.  And, I have applied for Remistart.

It just seems very strange (even if I don't have to pay the large dollar amount) that these hospital pharmacy's prices are so very much different for the same exact dosage of Remicade.

It would be like getting an asprin at one hospital for $1.00 and then being charged $5.00 for the same  asprin at another hospital.  

I've had Remicade infusions now for almost two years and I do know you don't buy it at a pharmacy.

But, the question still remains, "how much difference in price can there possible be between states?"

Hope I cleared up any prior misunderstanding.

Thanks

 

 


LuvsScottygirls
New Member


Date Joined Jul 2007
Total Posts : 9
   Posted 2/17/2009 5:23 PM (GMT -6)   
I need to add that I am still curious as to how much you pay for treatments around the states (or out of country).
Just trying to figure out these vast dollar differences between states and hospitals.
Thanks for any information

Mamas Boys
Veteran Member


Date Joined Oct 2005
Total Posts : 1460
   Posted 2/17/2009 5:24 PM (GMT -6)   
Maybe it has to do with the pricing the hospitals themselves get for the drug.  Maybe different hospitals get better prices based on quantity purchased or other factors.  Just guessing here.  Anyone else have an idea?

Mamas Boys (aka KTM)
Colazal, Azathioprine, Remicade
Culturelle, MultiVitamin, Folic Acid, Viactiv
Status: Remission!!


LuvsScottygirls
New Member


Date Joined Jul 2007
Total Posts : 9
   Posted 2/17/2009 5:57 PM (GMT -6)   

The different cost to the hospital idea would make sense if we were talking a couple thousand dollars or so but a difference of $13,000.00 and more for the same medicine makes no sense at all.

These two state, Wyoming and Arizona, are only 1200 miles apart.  How can a drug cost more than $1000.00 per mile between two states?

I have to think there are some Medicade or Medicare charges being billed out to the many elderly folks.

The insurance companies, doctors, nurses, and even the pharmacies that I've talked to are surprised by the hugh difference in price.

The one and only answer I've received from the billing departments is, "It's just the way it's billed out." 

This drug is already a very expensive item for those of us who have to have it - to apply that kind of increase to the cost is criminal.

Thanks for your input 


Eva Lou
Veteran Member


Date Joined Sep 2006
Total Posts : 3442
   Posted 2/17/2009 6:24 PM (GMT -6)   
have you asked the pharmacies if they have any input as to why the drug costs vary so much? At the hospitals, I mean. I have no idea why a hospital would pay so much more or less than another hospital- well, actually I do- I don't think Medicare/Medicaid absorbs the costs, but I bet the state-funded insurance plans do! I mean- when someone goes to a hospital with no insurance, they are treated- that cost gets thrown back onto the taxpayers in that state. So if you have a hospital that treats many uninsured/underinsured patients, then the costs for everything provided by that hospital will go up. Know what I mean? I live in Massachusetts, & it's become a big problem, the uninsured getting care & every other working stiff footing the bill! This is just an idea though, it could be totally unrelated. Doesn't Arizona have a high percentage of seniors? And I bet most of them have Medicare/Medicaid, which only pays out so many dollars per procedure. So that may explain why the cost in AZ is so much higher than in Wyoming. Wyoming has a lower population overall than AZ, & I'd venture to guess that the senior population is smaller also. So the hospital in AZ charges more for everything, most likely, than the hospital in WY. You figure from the hospitals point of view, the insurance companies are the ones paying most of the increased costs. I don't know though.... just thinking aloud! I wonder what you'd find though if you were to compare prices for a "routine" surgical procedure, or prices for a private room rate. If those costs would differ significantly.
diagnosed with UC '02
meds-
Asacol- 8 tabs/day
Remicade-10mgs/kg- since 4/07
Imuran- 150mgs/day
Culturelle
Fiber supplement
 
 
 


LuvsScottygirls
New Member


Date Joined Jul 2007
Total Posts : 9
   Posted 2/17/2009 9:54 PM (GMT -6)   

Some very good thoughts Eva.  Thank you.  I had not thought of State Insurance.  I do know that our hospital in WY receives county funds.  But, surely all the AZ hospitals can't be on the same plan. 

 I do like the idea of comparing other procedures.

Other medicines (prescriptions) are very similiar in cost from state to state.   And, colonoscopies have been very close in price.  Those were Scottsdale Mayo Clinic compared to two different hospitals in WY. 

I had considered the older population here in AZ and thought Medicare and Medicaid may be involved.

Explainations about the price difference by the staff at pharmacies within the hospitals were pretty standard  "different hospitals have different charges".  One said, "Well, maybe in Wyoming they get a better deal on their Remicade - maybe they have found a less expensive supplier".  $13,000.00 plus less?  I don't think so.  Especially in Wy where they do far fewer infusions than in a more populated state like AZ.

It remains a puzzle.

I appreciate all the input.

Thanks


Katmom
Veteran Member


Date Joined Mar 2008
Total Posts : 1202
   Posted 2/17/2009 10:31 PM (GMT -6)   
Remicade is not even covered for children. Out insurance denied it. Was told in Chgo., that the cost was 10k per infusion and that was when she was only on the 5mg per kilo dose. Now on 10 mgs. per kilo. Luckily we got in a drug trial sponsored by Centacor, and it is fully paid till October. Then...who knows? If we get some kind of override at BC/ BS of IL they MAY cover it. We have to hit near 20k out of pocket before it is covered at 100%. We have hit that two years in a row.... 80-20 sounds fine, but the deductible is a bummer. Keep me posted on your findings. I may move! :-)
Daughter,15 diagnosed 1-08 w/ UC .
Asacol, Prevacid, Flagyl, Prednisone 50mg, major flare, now off!, Hosp. four x this yr. Low residue diet still, an
6MP, Colazal ,horrible acne/moon for awhile- No more Pred,but 6mp isn't working. Cortifoam enemas 4xweek
Trying probiotics, Niferex, fish oil, and Mangosteen for kicks.
update:
Had 4th infusion of Remicade(12-08), and still on all of the other drugs, except Flagyl and Pred. Better, no remission. In a drug trial for children. Living on a flare's edge.


LuvsScottygirls
New Member


Date Joined Jul 2007
Total Posts : 9
   Posted 2/18/2009 10:13 AM (GMT -6)   
Continue to check this site Katmom. 
Hopefully you will get some more ideas on cost and areas.
 
For the amount you are being charged you could drive or fly to a hospital that had a more resonable price.  The quotes I got were based on 440 mg - you said your daughter is taking 10 mg.   I would think there would be a hospital that charges far less than $10,000.00 for that amount of Remicade.
 
That's why it's important to check around.  It's not enough to let the insurance cover it and say oh well.  If hospitals have access to less expensive Remicade (or any other drug), they have an obligation to treat people for a reasonable price.
 
Katmom, check Mayo in your area.  We have a Mayo in Scottsdale.  Their pharmacy fumbled around a neighborhood of $5000.00 for 440mg of Remicade.  Their billing office; however, would not offer a charge - they said they needed time and would get back to me in a couple days.  It's been 5 days now and I have not heard from them.  But, do check around.
 
I, too, was on all the drugs that your daughter is on.  The Remicade really works for me and I am now off all but one medicine.  I hope you have good results with the treatments.
 
Good luck with your search.  I will keep your family in my thoughts
I wish you well   
 
 
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