Re: Health care reform impact on Xolair users

[Guest guest]

I don't know that it's helpful to start these discussions at such an early

stage. However, Genentech's website offers a Medicaid/Medicare search feature

for its drugs.

http://www.genentechaccesssolutions.com/xolair/patient/resources/medicare.jsp?st\

ate=NC

Currently it appears that Xolair may be covered under part B or part D depending

on the circumstances and requires prior authorization regardless of whether it

is covered under B or D, at least according to the Cigna Medicare website.

http://www.cigna.com/cgi-bin/DrugListMAPD10.cgi

Addy

Group co-owner

>

> Lets have a discussion on what Xolair users can expect to happen under the new

health care reform.

>

> I sense how the deer in the headlights feels as I try to comprehend the

changes that may be ahead.

>

> For instance, people who currently can't get insurance and are forfeiting

their life savings for Xolair should be able to get insurance soon, but it will

be in the form of a high risk pool in the early years, so who knows what this

will cost??

>

> And has anyone heard what kind of assistance low income folks will be able to

get for their insurance premiums, especially those that wind up in the high risk

pool?

>

> Will Xolair treatment be handled as a medical treatment, or as a drug, under

regular insurance plans?

>

> For Medicare recipients, will Xolair be covered under Part D, or will it be

covered under Part B as a medical treatment?

>

> And if handled as a drug how will this affect people on Medicare. I

understand the pharmaceutical companies are going to pay 1/2 of the cost for

drugs for Medicare recipients in the donut hole and the government will kick in

something like a $250 tax credit but how does this really play out in terms of

out-of-pocket costs for Medicare recipients. Will the pharmaceutical company

assistance effectively just widen the donut hole, or will it in fact reduce the

Medicare recipients out-of-pocket payments by 50%? And I understand this will

be changing over the years as the donut hole is slowly eliminated.

>

> I realize there's too many questions here for anyone to answer at once but

hopefully a general forum discussion can follow as information is dribbled out

on how Xolair users will be affected.

>

> Hopefully we won't have to hire an accounting firm to figure out what we're

going to have to pay for Xolair shots.

>

[Guest guest]

I got a shot right after the healthcare bill was passed.  So I asked how this

bill would affect my payments for my xolair (right now, I am on medicare and

have a supplemental insurance.  It is treated like cancer therapy.)  The

answer is::: " I don't know. "   So I think it may be a waiting game for a month or

so until the insurance companies, doctor's offices and accountants get this

figured out.....Just guessing.....

From: mister_manganese <barryb@...>

Subject: [ ] Health care reform impact on Xolair users

Date: Saturday, March 27, 2010, 12:54 AM

 

Lets have a discussion on what Xolair users can expect to happen under the new

health care reform.

I sense how the deer in the headlights feels as I try to comprehend the changes

that may be ahead.

For instance, people who currently can't get insurance and are forfeiting their

life savings for Xolair should be able to get insurance soon, but it will be in

the form of a high risk pool in the early years, so who knows what this will

cost??

And has anyone heard what kind of assistance low income folks will be able to

get for their insurance premiums, especially those that wind up in the high risk

pool?

Will Xolair treatment be handled as a medical treatment, or as a drug, under

regular insurance plans?

For Medicare recipients, will Xolair be covered under Part D, or will it be

covered under Part B as a medical treatment?

And if handled as a drug how will this affect people on Medicare. I understand

the pharmaceutical companies are going to pay 1/2 of the cost for drugs for

Medicare recipients in the donut hole and the government will kick in something

like a $250 tax credit but how does this really play out in terms of

out-of-pocket costs for Medicare recipients. Will the pharmaceutical company

assistance effectively just widen the donut hole, or will it in fact reduce the

Medicare recipients out-of-pocket payments by 50%? And I understand this will be

changing over the years as the donut hole is slowly eliminated.

I realize there's too many questions here for anyone to answer at once but

hopefully a general forum discussion can follow as information is dribbled out

on how Xolair users will be affected.

Hopefully we won't have to hire an accounting firm to figure out what we're

going to have to pay for Xolair shots.

[Guest guest]

I am looking forward to the health care coverage. My ENT told me that even with

my health insurance, it iwll help with my copays. My husband and I have good

income but copays and meds eat a lot of that up. He told me that he has so many

patients with no coverage and now he looks forward to being able to help them

even more. I know a lot of people are not looking at the big pictures and the

entire 2000 page bill has not been read or available for all of us to see but I

am happy for everyone that needs it. Here in Atlanta we have had several news

story about patients with special needs and no help available and now there is

light at the end of the tunnel for them. It may not help everyone but for those

desperatly in need it will be a blessing.

Gwendolyn Rafter

From: mister_manganese <barryb@citiescommer ce.com>

Subject: [ ] Health care reform impact on Xolair users

Date: Saturday, March 27, 2010, 12:54 AM

 

Lets have a discussion on what Xolair users can expect to happen under the new

health care reform.

I sense how the deer in the headlights feels as I try to comprehend the changes

that may be ahead.

For instance, people who currently can't get insurance and are forfeiting their

life savings for Xolair should be able to get insurance soon, but it will be in

the form of a high risk pool in the early years, so who knows what this will

cost??

And has anyone heard what kind of assistance low income folks will be able to

get for their insurance premiums, especially those that wind up in the high risk

pool?

Will Xolair treatment be handled as a medical treatment, or as a drug, under

regular insurance plans?

For Medicare recipients, will Xolair be covered under Part D, or will it be

covered under Part B as a medical treatment?

And if handled as a drug how will this affect people on Medicare. I understand

the pharmaceutical companies are going to pay 1/2 of the cost for drugs for

Medicare recipients in the donut hole and the government will kick in something

like a $250 tax credit but how does this really play out in terms of

out-of-pocket costs for Medicare recipients. Will the pharmaceutical company

assistance effectively just widen the donut hole, or will it in fact reduce the

Medicare recipients out-of-pocket payments by 50%? And I understand this will be

changing over the years as the donut hole is slowly eliminated.

I realize there's too many questions here for anyone to answer at once but

hopefully a general forum discussion can follow as information is dribbled out

on how Xolair users will be affected.

Hopefully we won't have to hire an accounting firm to figure out what we're

going to have to pay for Xolair shots.

[Guest guest]

>

> I am looking forward to the health care coverage. My ENT told me that even

with my health insurance, it iwll help with my copays. My husband and I have

good income but copays and meds eat a lot of that up. He told me that he has so

many patients with no coverage and now he looks forward to being able to help

them even more. I know a lot of people are not looking at the big pictures and

the entire 2000 page bill has not been read or available for all of us to see

but I am happy for everyone that needs it. Here in Atlanta we have had several

news story about patients with special needs and no help available and now there

is light at the end of the tunnel for them. It may not help everyone but for

those desperatly in need it will be a blessing.

>

> Gwendolyn Rafter

>

Now since my insurance has to take people with pre existing conditions, where is

the company going to get the extra funds to pay for those claims?

I am afraid it is going go be my pocket. I am paying 903.00 a month as it is.

If it is upped a lot more, I won't be able to afford it.

The government subsidies to help me pay those premiums won't kick in till 2014.

Doug

Group founder

[Guest guest]

Doug, I thought I read where the pre-existing condition acceptance only applies

to children in the early part of the program. If so, I would think the hit on

insurance rates wouldn't be to bad, since as a group, children are not big

consumers of medical services.

But on the other hand, I read where insurance companies are to establish

high-risk insurance pools for people with pre-existing conditions in the early

part of the program, and of coarse high-risk translates to high-cost.

IMHO the summary: children will be covered and the hit won't be too bad on

others, but if you're an adult and don't have insurance and have a pre-existing

condition you probably still can't afford insurance. You can dream that you

will get insurance sometime, but won't really learn the bad news until after the

Fall elections.

So right now I can only guess our latest " duck and cover " responses will be

conditioned on the phase-in of features of the bill. I doubt there will be any

air-raid sirens, errr, I mean insurance-raid sirens to warn the public so that's

why I think we have to have our own early-warning system, like these

discussions.

I don't mean to sound negative about this bill. The U.S. health coverage system

has been horribly broken and I think the bill is a first step toward recovery.

But I really doubt it will be anything close to a full recovery ... just an IV

line to give us some hope.

> >

> > I am looking forward to the health care coverage. My ENT told me that even

with my health insurance, it iwll help with my copays. My husband and I have

good income but copays and meds eat a lot of that up. He told me that he has so

many patients with no coverage and now he looks forward to being able to help

them even more. I know a lot of people are not looking at the big pictures and

the entire 2000 page bill has not been read or available for all of us to see

but I am happy for everyone that needs it. Here in Atlanta we have had several

news story about patients with special needs and no help available and now there

is light at the end of the tunnel for them. It may not help everyone but for

those desperatly in need it will be a blessing.

> >

> > Gwendolyn Rafter

> >

>

>

> Now since my insurance has to take people with pre existing conditions, where

is the company going to get the extra funds to pay for those claims?

>

> I am afraid it is going go be my pocket. I am paying 903.00 a month as it is.

If it is upped a lot more, I won't be able to afford it.

>

> The government subsidies to help me pay those premiums won't kick in till

2014.

>

> Doug

> Group founder

>

[Guest guest]

>

> Doug, I thought I read where the pre-existing condition acceptance only

applies to children in the early part of the program. If so, I would think the

hit on insurance rates wouldn't be to bad, since as a group, children are not

big consumers of medical services.

>

> But on the other hand, I read where insurance companies are to establish

high-risk insurance pools for people with pre-existing conditions in the early

part of the program, and of coarse high-risk translates to high-cost.

>

> IMHO the summary: children will be covered and the hit won't be too bad on

others, but if you're an adult and don't have insurance and have a pre-existing

condition you probably still can't afford insurance. You can dream that you

will get insurance sometime, but won't really learn the bad news until after the

Fall elections.

>

> So right now I can only guess our latest " duck and cover " responses will be

conditioned on the phase-in of features of the bill. I doubt there will be any

air-raid sirens, errr, I mean insurance-raid sirens to warn the public so that's

why I think we have to have our own early-warning system, like these

discussions.

>

> I don't mean to sound negative about this bill. The U.S. health coverage

system has been horribly broken and I think the bill is a first step toward

recovery. But I really doubt it will be anything close to a full recovery ...

just an IV line to give us some hope.

>

Thanks, this makes me feel somewhat better but I am still dreading next year's

increase.

Doug

[Guest guest]

Doug:

I think it is a myth we are not paying for pre-existing conditions excluded

patients now. Now, we pay for the excluded when they wait too long to get care,

show up with the hospital with more expensive illnesses, and taxpayers and

patients reimburse the hospitals who charge more to cover these patients.

Under the proposal, they will be covered, can get care and avoid those more

expensive illnesesses, and they have are required to pitch in and pay.

Health insurance is going up anyway. This year, my new employer insurance costs

me $400 a month for xolair when the prior policy only charged me $100 a month.

That's just for the xolair co-pay, I am not talking about the premiums each

month I have to pay.

So I think the real question is whether we want to pay extra to provide profits

for insurance company executives and shareholders or use that extra money to

cover those without insurance. That is an easy question for me.

And if more people are able to use xolair, perhaps the price will further come

down.

> >

> > I am looking forward to the health care coverage. My ENT told me that even

with my health insurance, it iwll help with my copays. My husband and I have

good income but copays and meds eat a lot of that up. He told me that he has so

many patients with no coverage and now he looks forward to being able to help

them even more. I know a lot of people are not looking at the big pictures and

the entire 2000 page bill has not been read or available for all of us to see

but I am happy for everyone that needs it. Here in Atlanta we have had several

news story about patients with special needs and no help available and now there

is light at the end of the tunnel for them. It may not help everyone but for

those desperatly in need it will be a blessing.

> >

> > Gwendolyn Rafter

> >

>

>

> Now since my insurance has to take people with pre existing conditions, where

is the company going to get the extra funds to pay for those claims?

>

> I am afraid it is going go be my pocket. I am paying 903.00 a month as it is.

If it is upped a lot more, I won't be able to afford it.

>

> The government subsidies to help me pay those premiums won't kick in till

2014.

>

> Doug

> Group founder

>

[Guest guest]

> > >

> > > I am looking forward to the health care coverage. My ENT told me that even

with my health insurance, it iwll help with my copays. My husband and I have

good income but copays and meds eat a lot of that up. He told me that he has so

many patients with no coverage and now he looks forward to being able to help

them even more. I know a lot of people are not looking at the big pictures and

the entire 2000 page bill has not been read or available for all of us to see

but I am happy for everyone that needs it. Here in Atlanta we have had several

news story about patients with special needs and no help available and now there

is light at the end of the tunnel for them. It may not help everyone but for

those desperatly in need it will be a blessing.

> > >

> > > Gwendolyn Rafter

> > >

> >

> >

> > Now since my insurance has to take people with pre existing conditions,

where is the company going to get the extra funds to pay for those claims?

> >

> > I am afraid it is going go be my pocket. I am paying 903.00 a month as it

is. If it is upped a lot more, I won't be able to afford it.

> >

> > The government subsidies to help me pay those premiums won't kick in till

2014.

> >

> > Doug

> > Group founder

> >

>

Thanks! I understand a little better now

Doug