Re: new expensive vaccines

[Guest guest]

I have been giving out Adacel since March. My cost per dose is $34.74 from vaccineshoppe.com, while my listed price is arbitrarily set to 150% or $55. Reimbursement has ranged from as low as $37.00 from Aetna to as high as $47.33 from Blue Cross/Blue Shield, so I'm not losing money on it so far. Currently there is a waiting list for Adacel due to a shortage. I have not bought Zostavax or Gardasil. SetoSouth Pasadena, CAIs anyone buying zostavax or HPV or Adacel for their practices yet? Seems like big outlay and I'm wondering if anyone is getting reimbursed.Lynn

[Guest guest]

I'm using HPV now - buy it direct for Merck, as it's cheaper that way. They still have a 90 day net on it right now. You may want to contact your top payer to clarify reimbursement. The "average wholesale price" which guides reimbursement is $144. and at least 2 big insurers in my area have set that as their reimbursement. The Merck price is $120. I take care of a number of teens and parents were asking for it. I have been scared about the money and clarified with all of them they would cover my cost if there was an insurance snafu. It was too important not to do it.Is anyone buying zostavax or HPV or Adacel for their practices yet? Seems like big outlay and I'm wondering if anyone is getting reimbursed.Lynn

[Guest guest]

Lynn, I am giving HPV vaccine, and it is being covered by most health plans. Merck was doing a special where you don't have to pay for the vaccine for 6 months. lynnhri wrote: Is anyone buying zostavax or HPV or Adacel for their practices yet? Seems like big outlay and I'm wondering if anyone is getting reimbursed.Lynn Bowey, MDEncanto Family Medicine, PLLC333 E. Virginia Ave, Suite 110Phoenix, AZ 85004email: encantofm@...website: encantofamilymedicine.net office fax cell

[Guest guest]

I am buying and giving the HPV vaccine. Got an account with Merck directly. So far have been paid for the full amount by PHCS. I am told that United, Oxford and Cigna are all on board for covering it.I think it is important.Maggie Carpenter, MDBrooklyn, NY

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[Guest guest]

I’ve given Adacel (received only one

bottle of 10 doses I believe). I haven’t tracked the reimbursement, but

it has been covered, and I’m not losing money on it.

Zostavax – gave to one lady who didn’t

care if her insurance covered it or not, haven’t received the EOB back

yet.

Gardasil – have it, and lots of

people interested in it, but are waiting until the new year when it is

anticipated to be covered.

A. Eads, M.D.

Pinnacle Family Medicine, PLLC

phone fax

P.O.

Box 7275

Woodland

Park, CO 80863

From: [mailto: ] On Behalf Of lynnhri

Sent: Sunday, October 15, 2006

7:43 PM

To:

Subject:

new expensive vaccines

Is anyone buying zostavax or HPV or Adacel for their

practices yet?

Seems like big outlay and I'm wondering if anyone is getting reimbursed.

Lynn

[Guest guest]

I have given about 20 Gardisil shots and have been well reimbursed (around 140) by everyone but UHC. They are currently reimbursing half of the charge, which they say is all my contract allows for vaccines they haven't fully entered into their system or something. So now, patients are signing an ABN for the Gardisil. I have given 3 Zostavax shots, all paid out of pocket by patients who know someone who had shingles. I couldn't get Adacel (patients have been asking for it) because they are changing factories and aren't selling it.

I bought small amounts of zostavax and gardisil from the merck rep, sent a letter out to my patients about their benefits and have done really well with it. I guess the good thing is that you can buy small amounts of the vaccine. Also, I live in area where the elderly I have seem to have saved well for retirement.

[Guest guest]

UHC said they would reimburse at the 140 rate starting Oct 1. M network rep also suggested resubmittting the older HPVs at $280 charge, at which point she thought I would get 140. I'm dubious, but will try once.I have given about 20 Gardisil shots and have been well reimbursed (around 140) by everyone but UHC. They are currently reimbursing half of the charge, which they say is all my contract allows for vaccines they haven't fully entered into their system or something.  So now, patients are signing an ABN for the Gardisil.  I have given 3 Zostavax shots, all paid out of pocket by patients who know someone who had shingles. I couldn't get Adacel (patients have been asking for it) because they are changing factories and aren't selling it.  I bought small amounts of zostavax and gardisil from the merck rep, sent a letter out to my patients about their benefits and have done really well with it.  I guess the good thing is that you can buy small amounts of the vaccine.  Also, I live in area where the elderly I have seem to have saved well for retirement. 

[Guest guest]

But how

much does the shot cost? $140 sounds great but not if the shot costs $138

each.

Re:

new expensive vaccines

UHC said they would reimburse at the 140 rate starting

Oct 1. M network rep also suggested resubmittting the older HPVs at $280

charge, at which point she thought I would get 140. I'm dubious, but will try

once.

I have given about 20 Gardisil shots and have been well reimbursed

(around 140) by everyone but UHC. They are currently reimbursing half of the

charge, which they say is all my contract allows for vaccines they haven't

fully entered into their system or something. So now, patients are

signing an ABN for the Gardisil. I have given 3 Zostavax shots, all paid

out of pocket by patients who know someone who had shingles. I couldn't get

Adacel (patients have been asking for it) because they are changing factories

and aren't selling it.

I bought small amounts of zostavax and gardisil from the merck

rep, sent a letter out to my patients about their benefits and have done really

well with it. I guess the good thing is that you can buy small amounts of

the vaccine. Also, I live in area where the elderly I have seem to have

saved well for retirement.

[Guest guest]

It costs 120. at Merck, more elsewhere. This is not a money maker.NBut how much does the shot cost?  $140 sounds great but not if the shot costs $138 each.  -----Original Message-----From: [mailto: ] On Behalf Of GuinnSent: Tuesday, October 17, 2006 9:10 AMTo: Subject: Re: new expensive vaccines UHC said they would reimburse at the 140 rate starting Oct 1. M network rep also suggested resubmittting the older HPVs at $280 charge, at which point she thought I would get 140. I'm dubious, but will try once. I have given about 20 Gardisil shots and have been well reimbursed (around 140) by everyone but UHC. They are currently reimbursing half of the charge, which they say is all my contract allows for vaccines they haven't fully entered into their system or something.  So now, patients are signing an ABN for the Gardisil.  I have given 3 Zostavax shots, all paid out of pocket by patients who know someone who had shingles. I couldn't get Adacel (patients have been asking for it) because they are changing factories and aren't selling it.  I bought small amounts of zostavax and gardisil from the merck rep, sent a letter out to my patients about their benefits and have done really well with it.  I guess the good thing is that you can buy small amounts of the vaccine.  Also, I live in area where the elderly I have seem to have saved well for retirement.   

[Guest guest]

Therein

lies the problem for me. The time it takes me to do these with no MA

makes them breakeven at best.

Re:

new expensive vaccines

UHC

said they would reimburse at the 140 rate starting Oct 1. M network rep also

suggested resubmittting the older HPVs at $280 charge, at which point she

thought I would get 140. I'm dubious, but will try once.

I have given about 20 Gardisil shots and have been well reimbursed

(around 140) by everyone but UHC. They are currently reimbursing half of the

charge, which they say is all my contract allows for vaccines they haven't

fully entered into their system or something. So now, patients are

signing an ABN for the Gardisil. I have given 3 Zostavax shots, all paid

out of pocket by patients who know someone who had shingles. I couldn't get

Adacel (patients have been asking for it) because they are changing factories

and aren't selling it.

I bought small amounts of zostavax and gardisil from the merck

rep, sent a letter out to my patients about their benefits and have done really

well with it. I guess the good thing is that you can buy small amounts of

the vaccine. Also, I live in area where the elderly I have seem to have

saved well for retirement.

[Guest guest]

Therein

lies the problem for me. The time it takes me to do these with no MA

makes them breakeven at best.

Re:

new expensive vaccines

UHC

said they would reimburse at the 140 rate starting Oct 1. M network rep also

suggested resubmittting the older HPVs at $280 charge, at which point she

thought I would get 140. I'm dubious, but will try once.

I have given about 20 Gardisil shots and have been well reimbursed

(around 140) by everyone but UHC. They are currently reimbursing half of the

charge, which they say is all my contract allows for vaccines they haven't

fully entered into their system or something. So now, patients are

signing an ABN for the Gardisil. I have given 3 Zostavax shots, all paid

out of pocket by patients who know someone who had shingles. I couldn't get

Adacel (patients have been asking for it) because they are changing factories

and aren't selling it.

I bought small amounts of zostavax and gardisil from the merck

rep, sent a letter out to my patients about their benefits and have done really

well with it. I guess the good thing is that you can buy small amounts of

the vaccine. Also, I live in area where the elderly I have seem to have

saved well for retirement.