Re: Walgreens and Xolair Pricing

[Guest guest]

>

> Hi,

> I don't post a lot on this list but this one drew my attention.

Walgreens

> does have a specialty pharmacy, this seems to just have come up

recently. I

> don't remember what it is called, it is not Walgreens though.

> I don't know a whole lot about this specialty pharmacy yet.

This is what my insurance company called it. No matter anyway because

my xolair will be at my doctor's office in time for my next two shots

Doug

[Guest guest]

Here is my last insurance statement:

doc visit $40; other services (I'm guessing this is the pft lung function

that I do each time) $29.60; Radiation/chemotherapy $51.60; Specialty RX other

sou $518.55. Total: $639.75; office visit not allowable; paid by medicare

$479.75; paid by my plan $119.95. total paid $599.75. This is for 150 mg, once

a month. Looks like my part without the medicare at $368 would have been 50%,

not 30% as I reported earlier. Sorry about that. I am NOT a mathemetician--I

am a retired English teacher and still work as a musician. I have never been

mathematically inclined!

At any rate, this is what my xolair is costing--maybe it is not overcharged as

I once thought......? I apologize for my errors in relating what was charged

for the xolair. I should have looked at my statement before I shot off my

email. This seems to be more in line with what everyone else is paying. Thanks

Fran for making me look at my statement instead of just glancing at it!

Have a great weekend all. I am a little short of breath today because of all

of the mountain cedar--but NO sinus infection!

Adah

uca79iii <bme1979@...> wrote:

>

> Hi,

> I don't post a lot on this list but this one drew my attention.

Walgreens

> does have a specialty pharmacy, this seems to just have come up

recently. I

> don't remember what it is called, it is not Walgreens though.

> I don't know a whole lot about this specialty pharmacy yet.

This is what my insurance company called it. No matter anyway because

my xolair will be at my doctor's office in time for my next two shots

Doug

---------------------------------

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[Guest guest]

Hi KCSTARNS - Medicare has ended the buy and bill program. Effective

this month, docs place the Xolair order with a Medicare specialty

pharmacy and the pharmacy, rather than the doc, bills Medicare and

bills the 20% copay to the patient or suplemental policy. The

changeover caused a 10-day delay in delivery of my dose, which I take

every 4 weeks. Hopefully that was just a one-time logistical glitch

that won't be recurring.

Fran

> $900 for 150 mg? Wow! I have straight Medicare and my doctor's

> office has been doing " Buy and Bill " or maybe it's the other way

around. At

> any rate, Medicare pays 80% of $500 for my 150 mg and so my 20%

copay is $100.

> The Xolair must not cost more than $500 to the doc since there's

no way he

> would be eating the overage. Now the Buy and Bill program has

ended and my

> Xolair will be sent to the doc from a specialty pharmacy. I'll

still be paying

> the same copay.

> --- In _ @ xol_

(mailto: )

> , Adah Voigt <asthmatic50@asthmatic

> For what it's worth, here is what I gather from my insurance

forms. When I

> get my insurance statement, as close as I can figure out, my 150mg

shot, once

> a month costs close to $900--just for the shot.

> The doctor's office charges $40 which is not allowable under

medicare or my

> supplemental, but the doctor told me at the beginning they would

absorb that

> cost since his clinic is also a research clinic for xolair (I am

not a part

> of the study). But just because that is what is says on the form

doesn't mean

> that is what it actually costs the clinic where I get my shot, as I

think

> they get the xolair in bulk supplies (or however it comes to them)

as they have

> about 100 patients (not a part of the research). I am just guessing

here. I

> figure 900 is close. Without medicare, my supplemental insurance co-

pay

> would have been $368, about 30% of just the cost of the xolair. I

am wondering

> what the cost is to others. My dose is the lowest they give. I

can't imagine

> what the cost must be for those who take twice that two times a

month!

>

> My experience has been the MD office must buy and bill for

medicare patients

> as Medicare will not cover the Xolair any other way. Also the

> administration fee is covered under the Medicare Part B plan. If

the administration fee

> is not being covered by Medicare I would inquire as to what CPT

and ICD-9 code

> is being billed to Medicare. Medicare reimbursement is based on

ASP

> (Average Sales Price) and not AWP (Average Wholesale Price). This

reimbursement

> rate is updated on a quarterly basis based on previous pricing

scales. This

> causes the MD office to sometimes receive a dollar or so above

cost and then it

> reverts to receiving less than cost until the next pricing

update. The

> manufacturer (Genentech/Novartis) sets the pricing and there are

no exceptions to

> this. The suppliers to the MD offices are the same specialty

pharmacies

> patients use to get their Xolair from. The pricing is the same

from any of the

> speciality pharmacies the MD chooses to order from. However, some

of the

> pharmacies have freight charges and some don't. There is

absolutely no price

> break in volume buying. The current purchase price is over $500.00

but not as

> high as $800.00. The manufacturer had two price increases in 2007.

>

> Kcstarns

>

>

>

>

> **************Start the year off right. Easy ways to stay in

shape.

> http://body.aol.com/fitness/winter-exercise?

NCID=aolcmp00300000002489

>

>

>

[Guest guest]

It is a source of great curiosity to me as to what my BCBS sub

company is paying for my Xolair. I saw the bill once from the

pharmacy - CuraScript (I think it was from them) and it was just

under $3,200.00 for the 28 day supply. I receive 375 mgs every 14

days at home. Since they send 3 vials of 150 mgs each I throw away

half of one bottle every 14 days......

I suspect, but do not know, that BCBS sub company is paying less than

half - maybe more like 1/3 or equal to what medicare pays. I pay

$45.00 co-pay for the 28 day supply. Really, I think that we have a

right to know exactly what our insurance actually is paying.

I do not see the doc for the shots but an office visit to a

specialist is $45.00 Throw in another $8.00 to $12.00 for parking and

$6.00 for gas. My co-pay for the doc is probably about equal to what

the insurance pays her also. My lab work is paid for - no co-pay.

There is a pft every 3 months.

I was definitely having improvement in sinuses too and then ... not

sure what happened but it came back so I'm back to the Sudafed

again! Nasal passages are open but there's pressure and aching in

the bones in my face.

--- In , Adah Voigt <asthmatic50@...>

wrote:

>

> Here is my last insurance statement:

> doc visit $40; other services (I'm guessing this is the pft lung

function that I do each time) $29.60; Radiation/chemotherapy $51.60;

Specialty RX other sou $518.55. Total: $639.75; office visit not

allowable; paid by medicare $479.75; paid by my plan $119.95. total

paid $599.75. This is for 150 mg, once a month. Looks like my part

without the medicare at $368 would have been 50%, not 30% as I

reported earlier. Sorry about that. I am NOT a mathemetician--I am

a retired English teacher and still work as a musician. I have never

been mathematically inclined!

>

> At any rate, this is what my xolair is costing--maybe it is not

overcharged as I once thought......? I apologize for my errors in

relating what was charged for the xolair. I should have looked at my

statement before I shot off my email. This seems to be more in line

with what everyone else is paying. Thanks Fran for making me look at

my statement instead of just glancing at it!

>

> Have a great weekend all. I am a little short of breath today

because of all of the mountain cedar--but NO sinus infection!

>

> Adah

>

[Guest guest]

The $3200 you saw on the Curascript bill sounds exactly right in

terms of what we know a Xolair vial costs. Six vials per month at

about $550 per vial would be $3300, right? That's what Medicare is

charged and it pays 80%, insured pays the 20% balance. Your BCBS

Explanation of Benefits (EOB) would show exactly what BCBS pays

Curascript, no more, no less. Unless I'm missing something here......

Fran

> >

> > Here is my last insurance statement:

> > doc visit $40; other services (I'm guessing this is the pft

lung

> function that I do each time) $29.60; Radiation/chemotherapy

$51.60;

> Specialty RX other sou $518.55. Total: $639.75; office visit not

> allowable; paid by medicare $479.75; paid by my plan $119.95.

total

> paid $599.75. This is for 150 mg, once a month. Looks like my

part

> without the medicare at $368 would have been 50%, not 30% as I

> reported earlier. Sorry about that. I am NOT a mathemetician--I

am

> a retired English teacher and still work as a musician. I have

never

> been mathematically inclined!

> >

> > At any rate, this is what my xolair is costing--maybe it is not

> overcharged as I once thought......? I apologize for my errors in

> relating what was charged for the xolair. I should have looked at

my

> statement before I shot off my email. This seems to be more in

line

> with what everyone else is paying. Thanks Fran for making me look

at

> my statement instead of just glancing at it!

> >

> > Have a great weekend all. I am a little short of breath today

> because of all of the mountain cedar--but NO sinus infection!

> >

> > Adah

> >

>

[Guest guest]

Ditto what Fran says,

Addy

> > >

> > > Here is my last insurance statement:

> > > doc visit $40; other services (I'm guessing this is the pft

> lung

> > function that I do each time) $29.60; Radiation/chemotherapy

> $51.60;

> > Specialty RX other sou $518.55. Total: $639.75; office visit not

> > allowable; paid by medicare $479.75; paid by my plan $119.95.

> total

> > paid $599.75. This is for 150 mg, once a month. Looks like my

> part

> > without the medicare at $368 would have been 50%, not 30% as I

> > reported earlier. Sorry about that. I am NOT a mathemetician--I

> am

> > a retired English teacher and still work as a musician. I have

> never

> > been mathematically inclined!

> > >

> > > At any rate, this is what my xolair is costing--maybe it is

not

> > overcharged as I once thought......? I apologize for my errors

in

> > relating what was charged for the xolair. I should have looked

at

> my

> > statement before I shot off my email. This seems to be more in

> line

> > with what everyone else is paying. Thanks Fran for making me

look

> at

> > my statement instead of just glancing at it!

> > >

> > > Have a great weekend all. I am a little short of breath

today

> > because of all of the mountain cedar--but NO sinus infection!

> > >

> > > Adah

> > >

> >

>

[Guest guest]

Thanks, Fran. Come to think of it I've never seen an EOB re Xolair

or any of the Rx's. When I go to Walgreens (just because it's close

and convenient) to buy other Rx's they say something like " your

insurance saved you $102.61 " but that of course is based on the price

Walgreens is using for their drugs. Re Xolair I've never seen what

the insurance actually pays - not even from Cura Script. Seems to be

a well guarded secret. With doctors I sometimes don't see the real

cost of the visit either although that varies with docs. I'm in a

private insurance plan, though. i.e., it's not medicare or medicaid

so there's no annual deductible - just co-pays and strong limits on

which docs I can see.

> > >

> > > Here is my last insurance statement:

> > > doc visit $40; other services (I'm guessing this is the pft

> lung

> > function that I do each time) $29.60; Radiation/chemotherapy

> $51.60;

> > Specialty RX other sou $518.55. Total: $639.75; office visit not

> > allowable; paid by medicare $479.75; paid by my plan $119.95.

> total

> > paid $599.75. This is for 150 mg, once a month. Looks like my

> part

> > without the medicare at $368 would have been 50%, not 30% as I

> > reported earlier. Sorry about that. I am NOT a mathemetician--I

> am

> > a retired English teacher and still work as a musician. I have

> never

> > been mathematically inclined!

> > >

> > > At any rate, this is what my xolair is costing--maybe it is

not

> > overcharged as I once thought......? I apologize for my errors

in

> > relating what was charged for the xolair. I should have looked

at

> my

> > statement before I shot off my email. This seems to be more in

> line

> > with what everyone else is paying. Thanks Fran for making me

look

> at

> > my statement instead of just glancing at it!

> > >

> > > Have a great weekend all. I am a little short of breath

today

> > because of all of the mountain cedar--but NO sinus infection!

> > >

> > > Adah

> > >

> >

>

[Guest guest]

You have the right to see all your bills whether for doctor's visits,

tests or medications. You should be able to get itemized bills for

Xolair if you ask Curascript, including older ones that your

insurance has already paid on.

> > > >

> > > > Here is my last insurance statement:

> > > > doc visit $40; other services (I'm guessing this is the

pft

> > lung

> > > function that I do each time) $29.60; Radiation/chemotherapy

> > $51.60;

> > > Specialty RX other sou $518.55. Total: $639.75; office visit

not

> > > allowable; paid by medicare $479.75; paid by my plan $119.95.

> > total

> > > paid $599.75. This is for 150 mg, once a month. Looks like my

> > part

> > > without the medicare at $368 would have been 50%, not 30% as I

> > > reported earlier. Sorry about that. I am NOT a mathemetician--

I

> > am

> > > a retired English teacher and still work as a musician. I have

> > never

> > > been mathematically inclined!

> > > >

> > > > At any rate, this is what my xolair is costing--maybe it is

> not

> > > overcharged as I once thought......? I apologize for my errors

> in

> > > relating what was charged for the xolair. I should have looked

> at

> > my

> > > statement before I shot off my email. This seems to be more in

> > line

> > > with what everyone else is paying. Thanks Fran for making me

> look

> > at

> > > my statement instead of just glancing at it!

> > > >

> > > > Have a great weekend all. I am a little short of breath

> today

> > > because of all of the mountain cedar--but NO sinus infection!

> > > >

> > > > Adah

> > > >

> > >

> >

>

[Guest guest]

If you get prescripts to Walgreens, you can register with them online. Then do a

history of your meds from year to year.

I have also gone on to my insurance website and have gotten the same info

hope this helps

tiredofsteroids <sitesee@...> wrote:

You have the right to see all your bills whether for doctor's visits,

tests or medications. You should be able to get itemized bills for

Xolair if you ask Curascript, including older ones that your

insurance has already paid on.

> > > >

> > > > Here is my last insurance statement:

> > > > doc visit $40; other services (I'm guessing this is the

pft

> > lung

> > > function that I do each time) $29.60; Radiation/chemotherapy

> > $51.60;

> > > Specialty RX other sou $518.55. Total: $639.75; office visit

not

> > > allowable; paid by medicare $479.75; paid by my plan $119.95.

> > total

> > > paid $599.75. This is for 150 mg, once a month. Looks like my

> > part

> > > without the medicare at $368 would have been 50%, not 30% as I

> > > reported earlier. Sorry about that. I am NOT a mathemetician--

I

> > am

> > > a retired English teacher and still work as a musician. I have

> > never

> > > been mathematically inclined!

> > > >

> > > > At any rate, this is what my xolair is costing--maybe it is

> not

> > > overcharged as I once thought......? I apologize for my errors

> in

> > > relating what was charged for the xolair. I should have looked

> at

> > my

> > > statement before I shot off my email. This seems to be more in

> > line

> > > with what everyone else is paying. Thanks Fran for making me

> look

> > at

> > > my statement instead of just glancing at it!

> > > >

> > > > Have a great weekend all. I am a little short of breath

> today

> > > because of all of the mountain cedar--but NO sinus infection!

> > > >

> > > > Adah

> > > >

> > >

> >

>

---------------------------------

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