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Topic: Price of Herceptin?

Forum: Stage IV and Metastatic Breast Cancer ONLY — A place for those managing the ups & downs of a Stage IV/metastatic breast cancer diagnosis. Please respect that this forum is for Stage IV members only or those posting on behalf of a Stage IV patient. There is a separate forum for Stage IV Caregivers/Family in "Support and Community Connections".

Posted on: Mar 14, 2009 11:05AM

respin wrote:

I apologize if I'm not on the right thread...I'm new to bc, and therefore fairly new to the workings of this board - diagnosed stage 4 right from the get go...

Just got my detailed bill from Sloan, and my herceptin drip is $7380! A quick calculation 17 weeks a year x 7380 = 125K .. a year! Holy cow.

I just can't wrap my head around it.  I know, welcome the world of medicine.

But, wow.

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Posts 1 - 24 (24 total)

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Mar 14, 2009 12:24PM Sassa wrote:

I know what you mean.  I calculated my year of herceptin at $142,000.

 We have to pay for those countries where the socialized medicine will paid the manufacturer  a much lower  amount than we pay and for the uninsured that get the drug for free.

Dx 11/6/2006, IDC, 1cm, Stage I, Grade 3, 0/9 nodes, ER-/PR-, HER2+
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Mar 14, 2009 12:27PM Fitztwins wrote:

Yup. Thank goodness for insurance.  We sure got our money's worth these past 4 years. No to mention the $$$$ out of pocket expenses.

Janis

Enjoy Every Sandwich.

Dx 12/12/2004, IDC, Stage IV, Grade 2, mets, ER+/PR+, HER2+Surgery 01/19/2005 Mastectomy (Left); Lymph Node Removal: Axillary Lymph Node Dissection (Left); Reconstruction: TRAM flap (Left)Chemotherapy 02/01/2005 Adriamycin, Cytoxan, TaxolRadiation Therapy 05/01/2005 ExternalTargeted Therapy 06/01/2005 HerceptinHormonal Therapy 01/01/2006 FemaraHormonal Therapy 06/02/2008 AromasinTargeted Therapy 07/01/2008 HerceptinTargeted Therapy 05/05/2010 TykerbHormonal Therapy 08/02/2012 TamoxifenHormonal Therapy 06/15/2013 Arimidex
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Mar 14, 2009 12:41PM LJ13 wrote:

Mine has been about $3k a pop in the Baltimore area.

Worry is a misuse of the imagination.

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Mar 14, 2009 12:59PM respin wrote:

So far I have a good ins. plan Cobra'd through my divorce...this runs out in next fall.  I'll have to make some decisions re: new insurance, new job, etc.

I haven't received anything from my ins. co yet, but I believe the drug will be covered by the pharm plan..which means I'll be footing 20% of the bill. ack.

Keep on keepin' on

Dx 2009, IBC, 4cm, Stage IV, 2/2 nodes, mets, ER+/PR+, HER2+
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Mar 14, 2009 03:35PM LuAnnH wrote:

I think my herceptin bill runs about 8K a shot! 

LuAnn --

Dx 7/2/2006, IDC, 2cm, Stage IV, mets, ER+/PR+, HER2+
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Mar 14, 2009 03:44PM AusAla wrote:

Respin,

Since herceptin is through infusion, it is not usually considered part of your pharmacy plan but is covered under medical.  That's the way it works with me.

"I don't want to be in a battle, but waiting on the edge of one I can't escape is even worse! Pippin, Lord of the Ring: Return of the King

Dx 5/13/2002, IDC, 2cm, Stage IV, Grade 3, 3/17 nodes, mets, ER+/PR+, HER2+
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Mar 14, 2009 04:06PM mason204 wrote:

As my socialized plan has decided to stop paying for my herceptin, I'm now looking at paying "out of pocket".  My insurance won't cover herceptin.  Let's see, $142K a year.  I don't think my house is worth that much.  I was curious about this thread because I suspected herceptin cost about that much but wasn't sure.

I'm trying not to freak out about this too much.  My children need a home and that appears to be my next option. 

I think it's time for me to start sitting on the corner with a tin cup.

Cheryl - Mets dx Aug/06 (lungs, liver, bones, abdomen)

Dx 12/23/2003, IDC, 5cm, Stage IV, Grade 2, 4/10 nodes, ER-/PR-, HER2+
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Mar 14, 2009 04:10PM LuAnnH wrote:

I thought you could get herceptin in Canada Cheryl, when did they stop paying for it?

LuAnn --

Dx 7/2/2006, IDC, 2cm, Stage IV, mets, ER+/PR+, HER2+
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Mar 14, 2009 04:29PM mason204 wrote:

When I stop and take a chemo break, my onc wants me to continue with Herceptin because she strongly believes it still continues to work with me.  Each time I've taken a chemo break, herceptin has kept me stable for as little as 6 months and as long as a year.  The government told her that because I'm metastatic and I went back on chemo again after mild progression, Herceptin obviously stopped working for me so why spend more money if it's not going to work after chemo.  Point taken, but everyone's different and I think this should be addressed on a case by case basis.  I don't think they're taking my prior history into account.

My onc suspects I have a new primary and not a metastatic spread.  If this is the case, they may relent.  I suppose that puts me into the category of having a "newly diagnosed cancer".  Weird - I don't understand it.

My guess is that the government is cracking down because of the recession and trying to cut costs.  It sounds drastic but it's cheaper for them if I'm dead.  That's a lot of money to spend on one person a year. My hubby calls me a pragmatist. Wink

I don't feel as though it's the government's responsibility to pay for my medicine.  I just wish that they made their decisions less heavy handedly.  Why pick and choose?  Because insurance assumes that the government pays 100% of the time, there's no safety net in place.  My insurance covers non-IV meds (cause the government covers this), hospital stays, etc.

I'm not going to panic yet, it doesn't do my healing any good.

Sorry for the long post, I'll get off my soapbox now.

Cheryl - Mets dx Aug/06 (lungs, liver, bones, abdomen)

Dx 12/23/2003, IDC, 5cm, Stage IV, Grade 2, 4/10 nodes, ER-/PR-, HER2+
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Mar 14, 2009 06:03PM LuAnnH wrote:

Cheryl, that doesn't seem right considering herceptin is not assumed to have failed just because you have a progression.  My onc said he feels it would be a couple of progressions on chemo with herceptin before he would give up on it.

LuAnn --

Dx 7/2/2006, IDC, 2cm, Stage IV, mets, ER+/PR+, HER2+
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Mar 14, 2009 06:21PM jeanne46 wrote:

Cheryl, is there any way you can appeal to the drug company that manufactures Herceptin (Genentech)?  Although they are recently is a buy out to Roche - they also manufacture Avastin and are doing (or so I thought) quite well financially.  My oncologist's office in the States suggested I do that in case my insurance company did not cover (they ended up covering) Herceptin or Avastin.

I know there has been a lot of debate as to when and in what instance to use these very expensive drugs on Stage IV patients - and it's doesn't look like it will be resolved soon.   I wish you the best of luck.  Perhaps your onc's office can help you with the appeal for financial assistance?

Dx 12/05, Stage IV, Grade 3 ER-/PR-Her2- YOU NEVER KNOW HOW STRONG YOU ARE UNTIL BEING STRONG IS THE ONLY OPTION YOU HAVE. -anonymous

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Mar 14, 2009 08:34PM abbyglp wrote:

Cheryl, What about your onc. switching you to tykerb. It does the same thing as herceptin and more (protects the brain) my onc tells me, that is why she switched me from herceptin to tykerb. But any way it is not an IV, it would be considered as a prescription? just a thought. hugs abby

Dx 5/5/2006, IDC, 5cm, Stage IV, Grade 2, 6/15 nodes, mets, ER+/PR+, HER2+
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Mar 14, 2009 10:32PM mke wrote:

I think the cost of a year's treatment with herceptin is about $40,000 in Canada.  What about the Trillium fund - would they pay for herceptin or tykerb?

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Mar 28, 2009 10:17AM, edited Mar 28, 2009 10:46AM by respin

             AusAla wrote:

              Respin,

              Since herceptin is through infusion, it is not usually considered part of your             pharmacy plan but is covered under medical. That's the way it works with me.

Well, I just got my insurance explanation of benefits, and they are treating it as a pharm...which means I have to pay $553.  I can't afford this drug. I'll try appealing to the ins. co (which means calling between working hours, and I can't afford any more time off to deal with this.)

I'm not  happy.

 Edited to add:

After calming down a bit and looking at it closer, my insurance halved the cost to $3690.   I just read my insurance booklet, it's technically not considered pharm, but outpatient services, which I am responsible for 15%.  (outpatient chemo/radiation/iv infusions.) This was for my first herceptin, 90 mins.  I can only *hope* that the rest of my treatments, 30 mins, will be much less than the original 7K.  

I need to research Medicare...is there anyone here who can give me some info?  (My biggest concern is that I'll be denied treatment that I now have available to me.)

Keep on keepin' on

Dx 2009, IBC, 4cm, Stage IV, 2/2 nodes, mets, ER+/PR+, HER2+
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Mar 28, 2009 01:46PM LuAnnH wrote:

I'm not on medicare yet but I can't believe herceptin is a pharm product!  It is an IV infused drug, although technically not a chemo but a targeted therapy.  I do remember though someone mentioned before that they had to get their tx administered in a hospital in order for them to be paid for.  Is that the case for you maybe?  Are you on medicare?  If so, you need to figure out a new plan to go with as soon as open enrollment opens up, in the meantime start applying to the drug mfg to get a grant to cover your costs.

LuAnn --

Dx 7/2/2006, IDC, 2cm, Stage IV, mets, ER+/PR+, HER2+
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Mar 29, 2009 01:27AM NYCarol wrote:

I'm on Medicare and they pay 80% of the Herceptin cost.  I have insurance that pays the other 20%.  I believe it is treated as a chemo "type" drug.

I know that those charges are really pared down and neither insurance companies nor medicare pay the kind of numbers you see on those bills.  Most have negotiated with the drug companies on all our chemo drugs.  I know it took about 15  years to develop Herceptin and get it approved.  No wonder we don't have a cure yet!

Dx 2002, IDC, <1cm, Stage IV, Grade 2, 0/2 nodes, mets, ER+/PR+, HER2+
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Jan 5, 2010 04:33PM wlily wrote:

Asking for an information.

I'm a Canadian living in Ontario, just had my second surgery yesterday Jan.04. The surgery doctor told me before it that I will most probably get treatment with Herceptin for a year. I don't know who supposes to pay it because I'm not working. Does the social medical insurance cover it in Ontarion?

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Jan 5, 2010 07:57PM mason204 wrote:

Hi wlily:

OHIP covers Herceptin for a year.  You don't have to pay.

This is a sore topic for me as I was off/on Herceptin for about 5 years.  One day the Ontario government decided they no longer wanted to cover my Herceptin so I had to stop.  Long story.  I had major progression afterwards until I resumed with Tykerb.

The government will cover you but only to a certain extent.  If you want Herceptin covered past the 12 month mark, your oncologist may have to do some "creative bookeeping" to keep you on it if you know what I mean.

Cheryl.

Cheryl - Mets dx Aug/06 (lungs, liver, bones, abdomen)

Dx 12/23/2003, IDC, 5cm, Stage IV, Grade 2, 4/10 nodes, ER-/PR-, HER2+
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Jan 5, 2010 08:11PM dawn16 wrote:

Im from Nfld and they covered me for the year following my initial dx after having a recurrence my onc has told me that I would be covered again.  If Not  well I guess I will start hounding my member of Parliment,  when it was initially approved there wasn't a time limit or amount of time put on it.  My source tells me that the government has approved Herceptin as part of our medical plan.  I don't know if it's just for nfld. or if every province is different.  But I would surely start climbing up the provincial government ladder to the top until I had some answers.

Dawn

Dawn

Dx 12/10/2006, IDC, 5cm, Stage IV, Grade 3, 8/18 nodes, mets, ER+/PR+, HER2+
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Jan 6, 2010 09:24AM Brenda_R wrote:

Herceptin is a Tier 4 drug and most insurance companies have that as a 33% co-pay.

That's what mine was. A little over $1200 every 3 weeks, with half of that being a provider discount, still leaving me with $608 every 3 weeks as co-pay. Then my insurance company decided that since my Onc wasn't buying the Herceptin from their authorized pharmacy that there would be no provider discount and I was responsible for the whole $1200.

I couldn't afford the $608 let alone the $1200. I told my onc and he wrote off my portion of the cost. Bless him.

Genentech also has a program that helps pay for the co-pays, if you meet their income requirements. 

Dx 12/12/2006, IDC, 3cm, Stage IIIa, Grade 3, 1/17 nodes, ER-/PR-, HER2+Surgery 12/29/2006 Lumpectomy (Right); Lymph Node Removal: Axillary Lymph Node Dissection (Right)Chemotherapy 01/28/2007 Adriamycin, CytoxanRadiation Therapy 05/01/2007 ExternalTargeted Therapy 07/10/2007 Herceptin
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Jan 6, 2010 09:45AM 1rarebird wrote:

The range of charges for Herceptin discussed here is incredible. For what it's worth, I get a Herceptin infusion of 180 mg every week (will get  52 treatments  before I am through) and each one costs right at $1,100 USD for the drug. The oncology center gets another $215 to put it in me. These are costs my HMO is paying. Add about 40% more for an approximate self-pay charge. I know they calculate the cost of the Herceptin by the amount that is used, since my dose has been changed a couple of times as my weight increased and then fell as a result of my chemo.

bird

Dx 5/15/2009, IDC, 1cm, Stage I, Grade 3, 0/5 nodes, ER+/PR+, HER2+
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Jan 6, 2010 11:53PM wlily wrote:

Hello Cheryl.  Thank you so much for the good news. Only so I can see the light for using Herceptin at least in the first 12 month, and mybe also after it with some idea. Here is a link to another news   http://ogov.newswire.ca/ontario/GPOE/2005/07/22/c3767.html?lmatch=&lang=_e.html   Wish you good luck in the furture treatment!

Good luck to Dawn & everyone who need Herceptin to get it enough paid by the government!! 

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Jun 2, 2010 07:46PM Sheedap wrote:

http://www.assertivepatient.com/2007/03/the_true_cost_o.html

I just came across this while looking for the cost of Herceptin, for my Mom. I'm quite shocked that the hospitals mark up that much. The doctor's fees and the hospital fees are charged separately. Why do hospitals need to markup that much?

why do distributors mark up that much? Is that because they hire and train the medical reps?

Any thoughts?

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Jun 2, 2010 09:35PM IwillBhealed wrote:

My Avastin is costing $11,000 a pop, times that by 9 treatments that i had already and more to come. I will be maxing out my benefits in no time.But hey its working so be it!!!Laughing

Dx 1/15/2010, ILC, 4cm, Stage IV, mets, ER+/PR-, HER2-