Walgreens and Xolair Pricing

[Guest guest]

uca79iii <_bme1979@..._ (mailto:bme1979@...) > wrote: Since

I changed to a different BCBS plan, they will be using Walgreens Specialty

Pharmacy instead of Medco.

I didn't know that Walgreens had one. Anyone else get their Xolair from

Walgreens?

Doug

Group founder

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.

tiredofsteroids <_sitesee@..._ (mailto:sitesee@...) > wrote:

$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

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