Re: Medical Office Visit costs

[Guest guest]

I had Blue Cross of CA last year and this year it is Anthem of CA (though we

live in VA.)

I get my Xolair through PrecisionRx's Specialty Pharmacy and pay $70 for a 3

month supply which is then shipped to my doctor's office. I then pay a $20

copay for the visit, plus $5.14 (though not sure what this is exactly. . So

my monthly Xolair shot costs me about $50 between the drug co-pay and the

doctor visit.

B.

From: [mailto: ] On

Behalf Of billybaroo1958

Sent: Monday, March 24, 2008 3:44 PM

Subject: [ ] " Medical Office Visit " costs

I am currently on Xolair through Blue Cross in California. I am

fortunate for the moment to receive the drug as part of my " pharmacy

plan " . I only have to pay the $20 copay. But, one, my doctor is

beginning to balk at allowing the self-injection and, two, Precision

RX SS constantly tells me with each re-fill that Blue Cross might

begin to disallow self-injection, which would thus make the Xolair

fall under the " Medical Office Visit " portion of my insurance.

The difference would be $20 co-pay per month under the self-injection

to 20% of the cost of each vile, about $100 per vile and $90 for each

injection. So, I go from $20 a month to about $580 per month. In

addition, I travel for a month or more at a time, so all my dosages

would be delivered to my office thus preventing me from self-injection

while I travel. Anyone else who faces a similar set of issues.

Personally, I believe Blue Cross CA has used the " black box " warning

to charge more for Xolair through the " medical office visit " part of

their plan.

[Guest guest]

I suspect you're right about BC/BS's motives - that's really

outrageous. Under current FDA regulations, whether or not you can

self-inject Xolair is up to you and your doc. Insurance companies

have no business meddling in that relationship but of course they do

it all the time. I suggest you raise the issue with the California

insurance commissioner and consumer affairs division or whatever the

similar agencies are called there. I would contact them now in

anticipation of the possible change rather than wait to see if it

will happen.

In Florida where I live, health insurance complaints are handled by

the state's consumer affairs agency but that differs from state to

state. It's astounding how quickly health insurance companies reverse

their inappropriate decisions very shortly after complaints are

filed. Perhaps you can have a role in making sure BC/BS never makes

the wrong decision about how they pay for Xolair. Please keep us

posted.

-Fran

--- In , " billybaroo1958 " <cajjz109@...>

wrote:

>

> I am currently on Xolair through Blue Cross in California. I am

> fortunate for the moment to receive the drug as part of

my " pharmacy

> plan " . I only have to pay the $20 copay. But, one, my doctor is

> beginning to balk at allowing the self-injection and, two,

Precision

> RX SS constantly tells me with each re-fill that Blue Cross might

> begin to disallow self-injection, which would thus make the Xolair

> fall under the " Medical Office Visit " portion of my insurance.

>

> The difference would be $20 co-pay per month under the self-

injection

> to 20% of the cost of each vile, about $100 per vile and $90 for

each

> injection. So, I go from $20 a month to about $580 per month. In

> addition, I travel for a month or more at a time, so all my dosages

> would be delivered to my office thus preventing me from self-

injection

> while I travel. Anyone else who faces a similar set of issues.

>

> Personally, I believe Blue Cross CA has used the " black box "

warning

> to charge more for Xolair through the " medical office visit " part

of

> their plan.

>

[Guest guest]

Hmmm... not sure how that is happening with Anthem and Precision RX

as your pharmacy provider? They are mine as well, and I was

emphatically told numerous times that I would pay 20% (per the

medical office part of my plan) of the charged cost of each vile of

Xolair. That worked out to over $400 for all four viles. Under the

pharmacy plan, which still qualifies it as a self-injectable, it is

a $20 co-pay and that is delivered to me. If Xolair gets delivered

to my doctor's office it automatically is considered as a " medical

office visit " . The bucks my doctor charges is just that she is

expensive, but I can't switch to another doctor as I might lose the

prescription.

>

> I had Blue Cross of CA last year and this year it is Anthem of CA

(though we

> live in VA.)

>

>

>

> I get my Xolair through PrecisionRx's Specialty Pharmacy and pay

$70 for a 3

> month supply which is then shipped to my doctor's office. I then

pay a $20

> copay for the visit, plus $5.14 (though not sure what this is

exactly. . So

> my monthly Xolair shot costs me about $50 between the drug co-pay

and the

> doctor visit.

>

>

>

> B.

>

>

>

> From:

[mailto: ] On

> Behalf Of billybaroo1958

> Sent: Monday, March 24, 2008 3:44 PM

>

> Subject: [ ] " Medical Office Visit " costs

>

>

>

> I am currently on Xolair through Blue Cross in California. I am

> fortunate for the moment to receive the drug as part of

my " pharmacy

> plan " . I only have to pay the $20 copay. But, one, my doctor is

> beginning to balk at allowing the self-injection and, two,

Precision

> RX SS constantly tells me with each re-fill that Blue Cross might

> begin to disallow self-injection, which would thus make the Xolair

> fall under the " Medical Office Visit " portion of my insurance.

>

> The difference would be $20 co-pay per month under the self-

injection

> to 20% of the cost of each vile, about $100 per vile and $90 for

each

> injection. So, I go from $20 a month to about $580 per month. In

> addition, I travel for a month or more at a time, so all my

dosages

> would be delivered to my office thus preventing me from self-

injection

> while I travel. Anyone else who faces a similar set of issues.

>

> Personally, I believe Blue Cross CA has used the " black box "

warning

> to charge more for Xolair through the " medical office visit " part

of

> their plan.

>

>

>

>

>

>