88 replies to this topic

[Dom]

Well, Express Scripts just wrote to say they miscalculated my share of imatinib, so the prices quoted above are false. Here are the real figures:

Total cost I pay Deductible
------------ --------- ----------------
Imatinib 400 (30 pills) 2073.01 818.25 400.00
Imatinib 100 (60 pills) 1121.90 280.48

The way I see it, 818.25 = 400 + 0.25(2073.01 - 400)
280.48 = 0.25(1121.90)

I'm not sure why Walmart gives me a "cash" quote (8252.27 and 4949.19 for the 400s and 100s respectively). That doesn't figure into anything.

By the way, don't you love that Walmart's price for imatinib 400 is 2073.01? Had to get that penny at the end!!!

[Buzzm1]

Well, Express Scripts just wrote to say they miscalculated my share of imatinib, so the prices quoted above are false. Here are the real figures:

Total cost I pay Deductible
------------ --------- ----------------
Imatinib 400 (30 pills) 2073.01 818.25 400.00
Imatinib 100 (60 pills) 1121.90 280.48

The way I see it, 818.25 = 400 + 0.25(2073.01 - 400)
280.48 = 0.25(1121.90)

I'm not sure why Walmart gives me a "cash" quote (8252.27 and 4949.19 for the 400s and 100s respectively). That doesn't figure into anything.

By the way, don't you love that Walmart's price for imatinib 400 is 2073.01? Had to get that penny at the end!!!

Dom; makes a hell of a lot more sense; your previous numbers made no sense whatsoever.

[Dom]

Buzz, any idea what the "cash" price is all about?

[Buzzm1]

Buzz, any idea what the "cash" price is all about?

I have been told by Kaiser (and quoted an exorbitant price) showing that without insurance, drugs are much more expensive.  They said that without insurance, Gleevec was $15,000/mo. when it was listed at about $9,000/mo.

[hannibellemo]

How ironic is that? When one doesn't have insurance, medical care in total (not just drugs) is more expensive!

[Melanie]

I've had the opposite experience. We have learn to always ask for the "cash" price for the non insured. Can't say we do that for the CML drugs, but my husband has had an ongoing eye infection that has required several very expensive eye drops. He's on Medicare and has Humana part D. One drop was $30 on a co pay assistance card, until they found out he was on Medicare. It then went up to $140 ( our cost). Shopped around, same story minus or plus $10. Then we heard about a pharmacy from the Dr office in a city 100 miles away. They took his insurance info and came back with $40 for the one drop and $130 for another. We said we could get the $130 one local for $35. They said, we can match that. They over-nighted the drops and we had them the next day.

Lesson, always ask if there's a better price! We've done the same for hospital charges, doctor visits, etc. Sometimes there's no benefit, but more often then not, they offer a lower price for cash. Seems there some wiggle room. 😊

[chriskuo]

It all depends on the price negotiated by the pharmacy chain, PBMs, and manufacturers.

The players keep these discounts secret as proprietary information. The discounts are weapons to woo employers and unions.
Some large chains such as Wal-Mart use low prices to woo customers.

Note that manufacturers are not allowed to give Medicare recipients copay cards. They must comply with the government prescribed discounts to Medicare Part D.

[hannibellemo]

Melanie,

 

I agree that it is possible to negotiate with medical providers (not sure about pharmaceuticals) to get a better deal but, in general, it seems to be necessary for the patient to begin the negotiations.

 

Although, a friend of mine was just offered 35% off their $100,000 Mayo bill for treatment of his melanoma if they would pay the remainder all at once. They have insurance, it's just not very good insurance.

[Melanie]

Yes, providers do offer discounts when you pay the balance in full, especially hospitals. When I was first dx, we had a $2500 deductible for the hospital. They offered us a 20% discount if we paid it in full, yet they would report the entire $2500 as being met to the insurance company. We said, deal and gave them our credit card. It worked out just as they said.

We now ask all providers about discounts and cash prices.

We think that pharmacy where we received the good deals just didn't run it through my husband's insurance. I'm going to check the web site to see.

[DebDoodah22]

All of this Medicare stuff makes me feel so hopeless - just at a time when I hoped things would be looking up!
I am now 65 and have been longing to retire, just feeling the need for a break from the 45-50 hour work week. The reduced dose of Sprycel 50mg has given me a bit more energy and stamina but its still a push. Hoping to reduce to 20 mg sometime this summer if my #s hold at .02%

I am doing what i can to keep working until i make 66 or 67 but reading these prices... I am wondering if it would even be wise to try to retire at all. I barely make ends meet with full insurance. Hopefully, I can achieve a period of drug free remission, but what about those who cannot? Who can pay these prices on a retirement income? I am so grateful to each of you who has posted your research or personal experience here. I wish I understood this better.

[Dom]

Deb, the prices we are quoting are the initial coverage price. Then comes the gap price which, yes, is a bit higher, but very quickly you enter the catastrophic stage. My price will drop from over 1,000 to about 120. Buzz, I think, will drop to just 12, lucky bastard.

For the whole year, I expect to pay about 6,500, which is less than my cobra, which was about 7,000.

[Buzzm1]

Deb, the prices we are quoting are the initial coverage price. Then comes the gap price which, yes, is a bit higher, but very quickly you enter the catastrophic stage. My price will drop from over 1,000 to about 120. Buzz, I think, will drop to just 12, lucky bastard.

For the whole year, I expect to pay about 6,500, which is less than my cobra, which was about 7,000.

Dom, even luckier yet, if, and when, I need to restart generic imatinib, Kaiser Senior Advantage has seen fit to classify it as a Tier 2 drug meaning that I will receive the generic imatinib prescription, regardless of dose, at a cost of $15/mo. ($180 for the entire year).  Unfortunately that only applies to generic imatinib and Kaiser isn't available in many locations.  Hopefully, as the generic imatinib price continues to drop, other Medicare related health plans will follow suit.   With Kaiser, the $12/Rx, applies during the Medicare catastrophic phase, for all drugs.

[hannibellemo]

Buzz,

 

Referring to your calculations for the cost to me of Sprycel for the remainder of the year (April-Dec); you were spot on!

 

Happy Spring!

[Buzzm1]

Thank you Pat.  Happy Spring to you also.  

 

btw, those who are on tier 5 generic imatinib have to pay their entire way through the first $4,950 (they aren't aided by a mfr. rebate while in the donut hole like those on patented medications are).  however, they do save more money in the catastrophic phase.

[shweflen]

date     total cost    I paid      deductible YTD       phase 2 YTD       coverage gap YTD

 

1/24      1593.82    698.45     400.00                    1593.82               698.45

2/27      1592.82    398.45                                    3187.69              1096.90

3/9            10.00      10.00                                    3197.69              1106.90

3/9            37.43      37.43                                    3235.12              1144.33

3/28       1593.82   691.96                                    3700.00              1836.29

 

In January I paid $400 deductible plus 25% of ($1593.82 - $400.00)

In February I paid 25% of $1593.82

In March, for two other generic drugs, I paid the total cost but their cost was credited to the phase 1 and coverage gap.

In March, for the imatinib, I paid 25 % of ($3700 - $3235.12) plus 51 % of the remainder in phase 2 which was $1128.94.

In April, May and June I expect to pay 51% of @1593.82

After that, for one month, I will pay 51% of whatever remains of the $4950 limit in phase 3 plus 5% of the rest of the total cost for that month.

Then, for the rest of the year, I will pay 5% of $1593.82.  I think.

date     total cost              I paid        deductible YTD      phase 2 YTD     coverage gap YTD

 

4/21       $1593.82           $812.85              $400                $3700                 $2649.18

[Buzzm1]

Thanks for the update on your Medicare Part D generic imatinib drug calculation shweflen.  Your PCR numbers are looking great.

[shweflen]

Buzzm1,  Thanks for the encouragement.  I have been lucky.  So far, 300 mg / day imatinib seems to be working and I only have minimal side effects, occasional diarrhea and upset stomach but nothing debilitating.  I am so glad to have found this forum and appreciate the expertise of you, Trey and the others.  It is really helpful to have a place to go with real world answers to my questions.  Thanks again.

[jmoorhou]

I have Kaiser and Medicare, I pay $100.00 for Kaiser a month, and $100 a month from my social security, and $15.00 a month for Teva generic Gleevec.  Kaiser is not in every state.  

[Dom]

Here's my update for the cost of express-scripts in the second month. I've repeats the previous information.

Drug and dose ............... Total cost .... I pay ........ Deductible
---------------------------- ..... ------------ ..... -------- ...... ----------------
Imatinib 400 (30 pills) ..... 2073.01 ..... 818.25 ..... 400.00
Imatinib 100 (60 pills) ......1121.90 ...... 280.48

Imatinib 400 (30 pills) ...... 1914.17 ...... 976.23
Imatinib 100 (60 pills) .......1062.90 ...... 416.71

The way I see it, the 100's were part initial phase, part gap, and the 400's were pure gap. Next month, I'm still in the gap, so it will cost a little more. Month after that, I'll be mostly in the gap, and then catastrophic, so it will cost less. Then it's pure catastrophic for the rest of the year. So far, I've paid 2491 for two months of imatinib. And I think I was right when I said earlier that I'll be out about 6500 for the year.

I need to pay about another 2380 to end the gap.

[Buzzm1]

Thanks for the update Dom.  $4,950 out-of-pocket ends the gap (donut hole) and then you will be at 5%.  I noticed that there has apparently been another price reduction in the cost of generic imatinib which answers another question I had been wondering about; that being whether there would be in-year reductions in the cost of the generic.   However, I also noticed that the new cost of your 100mg pills is basically the same as shweflen has been paying since the beginning of the year.   Go figure.

 

Dom, what's your latest PCR reading?