Re: Re: Rant/was How much would you pay

[Guest guest]

when you retire and are on medicare, you will also obtain a drug coverage policy

er from a provider it will cover xolair. you will probably pay for one month's

worth a year while you are in the donut hole aka gap period.

mister_manganese <barryb@...> wrote:

I'm taking Xolair now because I have an employer plan that covers it

for the moment, but they're hiking up the copays big time and in the

not-to-distant future I'll retire and have to depend on Medicare

anyway so I'll be turning to other medications, even if less

effective.

The phenominal amount drug companies are charging for some of these

medications smacks of greed and you see where that finally got Wall

Street. What we see now is capitalism crumbling because the

regulators didn't regulate and without regulation the capitalists

becoame intoxicated with greed.

They say the pendulum doesn't stop in the middle. Socialism is the

other side of the swing and the big bailout of our financial system

(effectively nationalization of the banking system) and latest

election suggests we may be there sooner than later.

Socialism and nationalization of the pharmeceutical industries may be

just what the Doctor ordered for the millions of baby-boomers

starting to retire and have to live on shriveled 401K's whose very

investments helped fund the drug companies.

>

> Finally, the makers of Xolair have an assistance

> program that can help you with the insurance transition. They may

be

> able to help you. I didn't ask and found out they would have helped

me

> avoid the missed dose I had if I had asked.

> Dharm

>

> My nurse recommended I talk to Genentech about a " debit card "

program when my copay went for $30 to $200 for a 3-month supply. I

felt funny doing it since I am not a hardship case, but she kept

telling me to do it. When I called the number she gave me, I was told

that because I have Medicare Part A (which pays for nothing), I am

ineligible. Blatant age discrimination!

> Now I'm not complaining about the $800-a-year out-of-pocket for the

medication, plus the doctor copays for " chemotherapy, " but I know

there are others who would need that assistance, and it won't be

available to them because of Genentech's discriminatory practices.

> Does anyone else think the drug companies are raking in money hand-

over-fist for some of these drugs that enhance quality of life? To

me, it is immoral that someone could be charged hundreds or thousands

of dollars a month for such medications. Drug companies can't argue

on behalf of R & D since that is not where the money goes -- they

charge what the market will bear, or in other words, what they feel

they can get out of sick people. And they use their profits for drug

pushing and for lobbying.

> Sorry, I know this isn't the point of the list, and Xolair is

definitely not the worst medication in which this is practiced. It

offends me that drug companies play off people's health and wellbeing.

> Thanks for letting me spout off.

> Carol

>

>

>

>

>

[Guest guest]

I am assuming that you will check on your medicare coverage before you retire. 

I don't know which state you live in, and I think the coverage is a little

different in each state, depending on which plan you decide to go with.  My mom

is under the old Secure Horizons which I think is now AARP.  She has a low

co-pay on some things and no copay on others.  I am on medicare, but I also have

supplemental insurance that we carry from my husband's employer before he

retired.  It is high, but it has been well worth the extra money each month as

we have some sort of doctor visit most months, and some months he and I both has

doctor's visits.  Right now I pay nothing for my xolair, but I would not be

surprised if at some point I will have a copay for it. 

 

The best advice on both fronts is to check out what kind of help you can get for

the xolair shots and check out all of the insurance possibilities before you

retire.  If you know other retirees, you might also ask them what they did.  By

the way, because our supplemental has a prescription program on it, we do not

have to worry about the donut hole.  There again, we did research before we

decided to stay with the supplemental that we have.  It does get mind-boggling

to say the least!

 

Good luck.....

From: mister_manganese <barryb@...>

Subject: [ ] Re: Rant/was How much would you pay

Date: Sunday, November 9, 2008, 2:09 AM

I'm taking Xolair now because I have an employer plan that covers it

for the moment, but they're hiking up the copays big time and in the

not-to-distant future I'll retire and have to depend on Medicare

anyway so I'll be turning to other medications, even if less

effective.

The phenominal amount drug companies are charging for some of these

medications smacks of greed and you see where that finally got Wall

Street. What we see now is capitalism crumbling because the

regulators didn't regulate and without regulation the capitalists

becoame intoxicated with greed.

They say the pendulum doesn't stop in the middle. Socialism is the

other side of the swing and the big bailout of our financial system

(effectively nationalization of the banking system) and latest

election suggests we may be there sooner than later.

Socialism and nationalization of the pharmeceutical industries may be

just what the Doctor ordered for the millions of baby-boomers

starting to retire and have to live on shriveled 401K's whose very

investments helped fund the drug companies.

--- In , Carol Corley <floridabouvs@ ...>

wrote:

>

> Finally, the makers of Xolair have an assistance

> program that can help you with the insurance transition. They may

be

> able to help you. I didn't ask and found out they would have helped

me

> avoid the missed dose I had if I had asked.

> Dharm

>  

> My nurse recommended I talk to Genentech about a " debit card "

program when my copay went for $30 to $200 for a 3-month supply. I

felt funny doing it since I am not a hardship case, but she kept

telling me to do it. When I called the number she gave me, I was told

that because I have Medicare Part A (which pays for nothing), I am

ineligible. Blatant age discrimination!

> Now I'm not complaining about the $800-a-year out-of-pocket for the

medication, plus the doctor copays for " chemotherapy, " but I know

there are others who would need that assistance, and it won't be

available to them because of Genentech's discriminatory practices.

> Does anyone else think the drug companies are raking in money hand-

over-fist for some of these drugs that enhance quality of life? To

me, it is immoral that someone could be charged hundreds or thousands

of dollars a month for such medications. Drug companies can't argue

on behalf of R & D since that is not where the money goes -- they

charge what the market will bear, or in other words, what they feel

they can get out of sick people. And they use their profits for drug

pushing and for lobbying.

> Sorry, I know this isn't the point of the list, and Xolair is

definitely not the worst medication in which this is practiced. It

offends me that drug companies play off people's health and wellbeing.

> Thanks for letting me spout off.

> Carol

>

>

>

>

>

[Guest guest]

If you are living mostly on social security and excluding you home, you have few

assets or other income is low, at least in Texas my mom has had help with her

prescriptions and pays very little copay and has not had to deal with the

donut.  I can find out what program it is.  Her case worker at Secure Horizons

and Senior Services was the one who sent us all of the info.  My husband and I

don't qualify because we have PO retirement and teacher retirement in addition

to our SS.  But our supplemental insurance covers our drugs.

 

From: mister_manganese <barryb@...>

Subject: [ ] Re: Rant/was How much would you pay

Date: Monday, November 10, 2008, 12:40 AM

Thanks for all the advice about Medicare coverage.

In summary, what I see is that Xolair would run me up to, through and

then beyond the Part D donut hole real quick. Since I don't have a

doctorate degreee in calculating Part D costs I estimate the costs as

follows:

Annual charges up to and through the donut hole = $3000

Annual charges beyond the donut hole for 5% catastrophic copay = $1000

Annual Medicare part D premium = %400

Total annual cost for Xolair = $4400

Then we're probably looking at another $500 in catastropic copay

coverage (thet's the 5% copay beyond the donut hole) for other

prescription drugs. So:

Total annual cost for all medications = $4900.

So a retiree with a devastated 401K plan living mostly on Social

Security will probably have to choose between food and medicine

unless they want to take up residence under a bridge somewhere to cut

down on housing costs.

Me ... well I'll learn to do without Xolair since I hate all that

freeway noise.

> >

> > Finally, the makers of Xolair have an assistance

> > program that can help you with the insurance transition. They may

> be

> > able to help you. I didn't ask and found out they would have

helped

> me

> > avoid the missed dose I had if I had asked.

> > Dharm

> >  

> > My nurse recommended I talk to Genentech about a " debit card "

> program when my copay went for $30 to $200 for a 3-month supply. I

> felt funny doing it since I am not a hardship case, but she kept

> telling me to do it. When I called the number she gave me, I was

told

> that because I have Medicare Part A (which pays for nothing), I am

> ineligible. Blatant age discrimination!

> > Now I'm not complaining about the $800-a-year out-of-pocket for

the

> medication, plus the doctor copays for " chemotherapy, " but I know

> there are others who would need that assistance, and it won't be

> available to them because of Genentech's discriminatory practices.

> > Does anyone else think the drug companies are raking in money

hand-

> over-fist for some of these drugs that enhance quality of life? To

> me, it is immoral that someone could be charged hundreds or

thousands

> of dollars a month for such medications. Drug companies can't argue

> on behalf of R & D since that is not where the money goes -- they

> charge what the market will bear, or in other words, what they feel

> they can get out of sick people. And they use their profits for

drug

> pushing and for lobbying.

> > Sorry, I know this isn't the point of the list, and Xolair is

> definitely not the worst medication in which this is practiced. It

> offends me that drug companies play off people's health and

wellbeing.

> > Thanks for letting me spout off.

> > Carol

> >

> >

> >

> >

> >

[Guest guest]

So true.  Also, when you retire, you can opt to keep your " employer " insurance,

of course at a higher rate, but with that and Medicare, the cost to retirees is

just for the prescription copays, which for us right now is 50% of the cost on

the low cost, since the drug coverage does not appreciably improve if we take

the " high " plan and pay more for it.  We had to take pencil and figures to paper

to figure out which was the most cost effective for us.

 

My drugs for my asthma, gerd (except now I take a generic which seems to be

doing just as well) and for my glaucoma add up to an average of about $400-$500

a month, and that's on retirement salary.  I have two part time jobs and then

substitute at a private school to supplement our retirement income which helps

to pay for my drugs.   My xolair costs me nothing--at least right now.

 

Before gas started going up, we had replaced our old van with an

economical Honda Fit for running around town and for my husband to use, so we

were very fortunate there that we got it when we did.

 

However, being retired these days is a little on the scary side!  And at 70,

there are not too many places other than Walmart or HEB who might hire us!

 

Yes, I think the drug companies have the poor and the seriously ill over a

barrel....It's all about greed and making a fortune.  I'm not opposed to

companies making money, but I am opposed to the greedy, uncompassionate manner

in which they do business.

 

Don't see things changing much in the next four years either.

 

 

 

From: Dharm Guruswamy <dguruswamy@...>

Subject: [ ] Re: Rant/was How much would you pay

Date: Monday, November 10, 2008, 2:39 PM

You have a good pulse on how many people feel. I am fortunate that I

have a secure job with an employer which provides good insurance.

Still, I notice that United Healthcare my current insurer last year

placed most asthma drugs including Advair in the THIRD tier. In my

plan, that means $50 a months co-pay retail, and $125 month co-pay

for up to 90 days via mail order! That means $500 a year for an astma

maintenance drugs. Assuming someone takes Advair alone that's $500 a

month. Add to that Singulair or other asthma drugs and the total for

a patient can easily exceed a $1,000. I can afford that amount, but

I know many patients with chronic asthma simply cannot afford

thousands of dollars in out of pocket. In my case, this scenario is

before I begin paying for Xolair which at a 10% coinsurance rate

means I pay $112 per dose until I hit the catostraphic limit. I wrote

a letter to United Healthcare's President about the issue of high co-

pays and as expected did not recieve a response. For many working

poor and middle class who HAVE insurance, healthcare is becoming

unaffordable.

For people like me, it means shorter vacations or putting off buying

a bigger condo after getting married. Basically, I eat about $3,000

out of pocket before all my costs are picked up under my High

Deducutible Health Plan (HDHP) and that's with a very low $6,000 out

of pocket maximum. The more typical limit is at or near the IRS

mandated limit which is in excess of $10,000 for family coverage! For

people who live paycheck the transition to High Deductible Health

Plans means they simply go without drugs that not only improve the

quality of their lives but may actually save their lives.

This is the situation for those who are employed and recieve their

coverage through their employers. I can't tell you how depressing it

is to see what happens to self employed people get sick. My advice to

anyone with chronic disease is to get a secure job with good health

insurance and stick it out. I some people don't like or even detest

the idea of working a nine to six job, but as someone who has been

self employed and in the individual health insurance market, DONT DO

IT! You may not like the idea of taking orders and going into work

everyday, but the being without insurance with a chronic disease like

asthma is worse in the long run.

Dharm Guruswamy

--- In , " mister_manganese " <barryb@...>

wrote:

>

> I'm taking Xolair now because I have an employer plan that covers

it

> for the moment, but they're hiking up the copays big time and in

the

> not-to-distant future I'll retire and have to depend on Medicare

> anyway so I'll be turning to other medications, even if less

> effective.

>

> The phenominal amount drug companies are charging for some of these

> medications smacks of greed and you see where that finally got Wall

> Street. What we see now is capitalism crumbling because the

> regulators didn't regulate and without regulation the capitalists

> becoame intoxicated with greed.

>

> They say the pendulum doesn't stop in the middle. Socialism is the

> other side of the swing and the big bailout of our financial system

> (effectively nationalization of the banking system) and latest

> election suggests we may be there sooner than later.

>

> Socialism and nationalization of the pharmeceutical industries may

be

> just what the Doctor ordered for the millions of baby-boomers

> starting to retire and have to live on shriveled 401K's whose very

> investments helped fund the drug companies.

>

>

[Guest guest]

Carol:  You are right about doctor's fronting the cost of xolair for medicare

patients.  For this reason, my regular allergist would not give me the shots

unless I would pay the copay for my other insurance.  I couldn't afford it with

the copayments for all of my other medicines.  So my allergist and his nurse

worked it out for me to go to a research clinic where they have a large number

of xolair patients--80 when I began, but the number has grown in the two and a

half years I have been going for the shot.  If this research doctor had not

accepted me, I would not be on xolair.  (I am not a part of a research group,

however, even though he is still doing research for xolair.)  I pay nothing for

my shots.  They are covered under the same section as chemotherapy.

when you retire and are on medicare, you will also obtain a drug coverage policy

er from a provider it will cover xolair. you will probably pay for one month's

worth a year while you are in the donut hole aka gap period.

[Guest guest]

i dont know what your doctor is doing BUT i order mine from Acredo and i pay the

deductible. the xolair is shipped directly to my doctor's office. my drug

coverage pays for it directly.

Carol Corley <floridabouvs@...> wrote: Are you

sure? My doctor's office said that for Medicare patients, they have to front the

cost of the medication and then be reimbursed, and they are choosing to not do

that.

Carol

Leigh wrote:

when you retire and are on medicare, you will also obtain a drug coverage

policy er from a provider it will cover xolair. you will probably pay for one

month's worth a year while you are in the donut hole aka gap period.

[Guest guest]

But I think Medicare adds a little something more to the mix. Carol is right

that the doctor's--allergist or pulmonoligist have to front the money for the

xolair and then send in a claim for reimbursement from Medicare, unless, as in

the case of the clinic where I get my shot, they have a large number of xolair

patients and a large number of those are on medicare.  If I remember rightly,

Fran did not pay anything for her xolair when she was getting her shots.  She is

the one who encouraged me to investigate medicare.

From: uca79iii <uca79iii@...>

Subject: [ ] Re: Rant/was How much would you pay

Date: Wednesday, November 12, 2008, 7:05 AM

Are you sure? My doctor's office said that for Medicare patients, they

have to front the cost of the medication and then be reimbursed, and

they are choosing to not do that.

> Carol

>

>

Mine has always been shipped straight to the allergist's office and

billed to my insurance who automaticallypays for the xolair AND the

doctor. I haven't seen a bill all year for anything related to my

xolair shots, only a statement from the insurance saying they have paid.

[Guest guest]

I get my shots at a clinic that does research trials for xolair.  Great

suggestion! 

From: Dharm Guruswamy <dguruswamy@...>

Subject: [ ] Re: Rant/was How much would you pay

Date: Wednesday, November 12, 2008, 10:18 AM

This is interesting discussion because I have none of the problems

many on the list do. First, my insurance does cover Xolair but more

importantly I don't have the problems of going to a hospital to get

Xolair.

My allergist not only prescribes my Xolair but also administers it.

Now he's also involved in a clinical trail for Xolair so even though

my insurance only reimburses the Xolair injections at the same rate

as allergy shots which is less than $17 he continues to administer

Xolair. The effort required to administer Xolair is considerabley

more than an allergy shot which is why I believe many doctors won't

administer the drug. However, as many of us know many doctors make

more money off clinical trials than they do on actually treating

patients so I would reccomend that try and find a provider who

participates in a clinical trial.

--

Dharm

--- In , " instdesgn1 " <instdesgn1@ ...>

wrote:

>

> I met with my new primary care physician today who was quite

> interested in my Xolair treatment and severe asthma. Actually, I

> stopped it 4-1/2 months ago because they required that I go to an

> infusion center which was too many $, too much time, too

incompetent,

> dirty, and with terminal patients all around me. I'm glad that my

> pulmo got me onto Xolair but the politics eventually ended my

> treatment.

>

> But, on to the topic related to this thread ... I said I had self

> injected for well over a year and am bright and well educated with

no

> problems w/self injection. It came out very clearly that there is

> sooooo much money to be made on Xolair and other monoclonal

> antibodies that a clinic is not going to let a patient slip thru

> their hands when they can collect that kind of big bucks

> administering to the patient in-house. That made a lot of sense

> because it is NOT required by the FDA that a patient be injected in

a

> clinic. It IS recommended but not required. It's the same with

> Genentech - it is not a requirement - just lots of dollars to the

> docs and clinics who administer in-house. I was surprised and

amused

> by his frankness. He actually started to suggest I come there but

> the distance is even greater plus ... I do not do clinics for

> Xolair. Genentech (and other pharmaceutical companies as Genentech

> is not the only one) and clinics are in bed together for $$$$ but

I'm

> not.

>

>

>