Re: CoPays and Insurance

[Guest guest]

Steve:

Is there another allergist in your city/town/community who would be

willing to give you the shots at the cost you have been incurring?

I am on medicare as well as a supplemental and the only way medicare

will pay for the xolair is what is called " buy and bill " and not all

of the doctors are willing to do that.

My allergist is still trying to decide. However, I live in a city

with a large number of allergists, allergy clinics, and asthma

clinics. If my doctor decides not to give me the shots he will send

me to a clinic who does give shots on the " buy and bill " plan, but

he will still be my primary doctor for my asthma. I will just go to

the clinic for my shots. Is there a possibility that another doctor

or clinic would be willing to give you the shots and accept whatever

your insurance pays?

Oh--if medicare does not decide to pay, my co-pay would be $250 a

month for my shot--once a month payable each month to the pharmacy

before they would send the vial! My med bill would then be 1/2 of

my retirement income. I do take two generic prescriptions, but one

of the generics I was on was not strong enough and the doctor put me

back on the name brand at $130+ copay monthly--up from $5 for the

generic! Being an asthmatic is not only hard physically, but it is

very costly and very hard to find help. Up to retirement, I had

been very fortunate in that my husband had government insurance

benefits and my employer paid for my health insurance, so between

the two, I paid very little for most of my drugs and very little for

my doctor's visits. However, since retirment the cost of my

medicine has been a strain on our retirement budget as we pay 50%

copay for all but generic medicines (and the high option is more

costly, but the drug benefits are about the same.) Fortunately, my

husband is only on one prescription right now and it costs $7 a

month!

However, in spite of the cost, I am so glad I am living right now

and that there are so many options for the treatment of asthma.

Hope you can get some help.

Adah

>

> OK, Here is what is happening. I just got of the phone with my

> allergist who informed me that I am forced to go through my

Pharmacy

> (Caremart) to obtain the Xolair which will more than double my

monthly

> fee for Xolair or discontinue the injections. My allergist is

doing

> this because they are currently writing off more that they are

actually

> getting reimbursed to them from BCBS as payment for the

medication.

> Apparently, she does not like receiving partial reimbursement and

> writing off the difference. She now wants full reimbursement or

> discontinue the injections.

>

> This is all fine and great for her but if I do it her way, I end

up

> paying $150.00 for each injection I receive which is one in each

arm

> twice a month with nothing going toward the copay limit of

$1,000.00.

> Even worse, I only get a portion of the vile in the second

injection

> and the rest of the Xolair is trashed.

>

> You say, why not have the pharmacy send the medication to me and I

give

> myself the injection. This does not reduce the cost. In fact it

will

> inincrease the cost of each injection from $50.00 to $150.00.

Anything

> send by or billed through the pharmacy does not go toward the

copay

> limit and my payments will go on forever. If we are forced to do

this

> it will increase our monthly medical expenses to a level that

exceeds a

> little over a half of MY monthly salary, which I cannot afford and

> continue providing what is needed for my family. This does not

include

> the medical expenses for my wife and two children which are less

but

> still add up.

>

> The current process allows me to pay only $75.00 for each shot

with the

> payment going toward the maximum copay limit of $1,000.00. This

good

> because when all my copay expenses (meds, pills, exams, testing,

etc. )

> reach this limit everything else is paid in full. .

>

> As a result of this change in financing, I need help locating a

better

> funding source. I have tried SPOC and it is useless. Caremart is

not

> willing to cooperate and the doctor is planning to discontinue

> providing injections after August unless a better payment process

can

> be worked out.

>

> Any and all suggestions are appreciated.

>

[Guest guest]

Contact Genetech yourself. I had to contact drug manufactuers when I had no

perscription coverage and they were very generous. Even with my husbands salary.

Karin

----- Original Message -----

From: Steve

Sent: Friday, June 23, 2006 10:59 AM

Subject: [ ] CoPays and Insurance

OK, Here is what is happening. I just got of the phone with my

allergist who informed me that I am forced to go through my Pharmacy

(Caremart) to obtain the Xolair which will more than double my monthly

fee for Xolair or discontinue the injections. My allergist is doing

this because they are currently writing off more that they are actually

getting reimbursed to them from BCBS as payment for the medication.

Apparently, she does not like receiving partial reimbursement and

writing off the difference. She now wants full reimbursement or

discontinue the injections.

This is all fine and great for her but if I do it her way, I end up

paying $150.00 for each injection I receive which is one in each arm

twice a month with nothing going toward the copay limit of $1,000.00.

Even worse, I only get a portion of the vile in the second injection

and the rest of the Xolair is trashed.

You say, why not have the pharmacy send the medication to me and I give

myself the injection. This does not reduce the cost. In fact it will

inincrease the cost of each injection from $50.00 to $150.00. Anything

send by or billed through the pharmacy does not go toward the copay

limit and my payments will go on forever. If we are forced to do this

it will increase our monthly medical expenses to a level that exceeds a

little over a half of MY monthly salary, which I cannot afford and

continue providing what is needed for my family. This does not include

the medical expenses for my wife and two children which are less but

still add up.

The current process allows me to pay only $75.00 for each shot with the

payment going toward the maximum copay limit of $1,000.00. This good

because when all my copay expenses (meds, pills, exams, testing, etc. )

reach this limit everything else is paid in full. .

As a result of this change in financing, I need help locating a better

funding source. I have tried SPOC and it is useless. Caremart is not

willing to cooperate and the doctor is planning to discontinue

providing injections after August unless a better payment process can

be worked out.

Any and all suggestions are appreciated.

[Guest guest]

I have Blue Cross and my allergist charges a " chemotherapy " fee as well as a

doctor visit fee, which gives them a very large income from Xolair patients. I

can't see why yours isn't making enough doing the same thing.

Carol