Does anyone know anything about this or who I should contact. We can't be the only one in this situation and it just doesn't seem right.
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Additional out-of-pocket expense for treatment
My Husband was diagnosed with multiple myeloma in February, 2013 and started his first Velcade, Decadron treatment 3/25/13. At that time the Est. for Services (out of pocket) was $260.53 per treatment. Just recently we were told that the Velcade has to be ordered in 35 units and not the 26 units indicated on the Estimate. My Husband is given 20 at a treatment. They informed us that we would be responsible for paying for the additional unused 15 that is destroyed because it cannot be kept until his next treatment. This is an additional $100 out of pocket per treatment.
Does anyone know anything about this or who I should contact. We can't be the only one in this situation and it just doesn't seem right.
Does anyone know anything about this or who I should contact. We can't be the only one in this situation and it just doesn't seem right.
Re: Additional out-of-pocket expense for treatment
Boy, that does seem to be an awful policy. A quick google on "Velcade 35 units" would suggest that this is the result of a canned, one-size-fits-all formula some insurance companies utilize. See this policy for both Medicare and Harvard Pilgrim:
https://www.harvardpilgrim.org/pls/portal/docs/PAGE/PROVIDERS/MEDMGMT/STATEMENTS/VELCADE_0413.PDF
https://www.velcade-hcp.com/reimbursement/forms/CMS-1450_withPI.pdf
I'd suggest you get the specific written rule/bulletin from your insurance company to challenge this.
https://www.harvardpilgrim.org/pls/portal/docs/PAGE/PROVIDERS/MEDMGMT/STATEMENTS/VELCADE_0413.PDF
https://www.velcade-hcp.com/reimbursement/forms/CMS-1450_withPI.pdf
I'd suggest you get the specific written rule/bulletin from your insurance company to challenge this.
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Multibilly - Name: Multibilly
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: Smoldering, Nov, 2012
Re: Additional out-of-pocket expense for treatment
You can find the official prescribing information for Velcade here:
http://www.accessdata.fda.gov/drugsatfda_docs/label/2012/021602s031s032lbl.pdf
This shows that the only form in which the drug is supplied is in a 3.5 mg single-use vial. It comes as a powder and must be mixed with 0.9% salt water to prepare it for injection. This results in much more than is needed for any one dose, and any that is not used within 8 hours must be discarded. So it seems that your provider is correct; the amount that must be purchased is the same for each dose, regardless of how much is used.
However, the calculation of how much of the cost is your share is another matter. You did not say what kind of insurance coverage you have, nor who told you the amount, nor how they calculated it. You should ask them to explain this in detail, and check what they say against the terms of your coverage. What you were told could easily be wrong.
If your share is difficult for you to pay, there are lots of programs to help cancer patients with such costs.
--Larry D'Addario
Pasadena, CA
http://www.accessdata.fda.gov/drugsatfda_docs/label/2012/021602s031s032lbl.pdf
This shows that the only form in which the drug is supplied is in a 3.5 mg single-use vial. It comes as a powder and must be mixed with 0.9% salt water to prepare it for injection. This results in much more than is needed for any one dose, and any that is not used within 8 hours must be discarded. So it seems that your provider is correct; the amount that must be purchased is the same for each dose, regardless of how much is used.
However, the calculation of how much of the cost is your share is another matter. You did not say what kind of insurance coverage you have, nor who told you the amount, nor how they calculated it. You should ask them to explain this in detail, and check what they say against the terms of your coverage. What you were told could easily be wrong.
If your share is difficult for you to pay, there are lots of programs to help cancer patients with such costs.
--Larry D'Addario
Pasadena, CA
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LarryD - Name: Larry D'Addario
- Who do you know with myeloma?: wife
- When were you/they diagnosed?: September 2012
- Age at diagnosis: 65
Re: Additional out-of-pocket expense for treatment
Here is a little more information relevant to your situation.
Although Velcade is supplied only as 3.5 mg single-use vials, it is possible to get more than one treatment per vial.
My wife is treated at Kaiser Permanente's oncology department in Los Angeles. Their chemotherapy unit has many patients on Velcade, and all are scheduled for treatment on Tuesday and/or Friday afternoons. Each patient requires a different amount of Velcade, but always less than 3.5 mg. Therefore, they mix up as much as is needed for all patients on a given day. This allows them to use fewer of the 3.5 mg vials than the number of patients, saving money.
At KP, the patient's cost for these treatments is not tied to the cost of the drug. Most patients pay nothing. Thus, any savings produced by the consolidation of treatments goes to the provider. Your situation seems to be different, although I still don't understand the rules of your coverage. If your cost is tied to the provider's cost, then perhaps you can save money by getting treated at a center that is able to treat many patients on the same day.
Best wishes,
Larry
Although Velcade is supplied only as 3.5 mg single-use vials, it is possible to get more than one treatment per vial.
My wife is treated at Kaiser Permanente's oncology department in Los Angeles. Their chemotherapy unit has many patients on Velcade, and all are scheduled for treatment on Tuesday and/or Friday afternoons. Each patient requires a different amount of Velcade, but always less than 3.5 mg. Therefore, they mix up as much as is needed for all patients on a given day. This allows them to use fewer of the 3.5 mg vials than the number of patients, saving money.
At KP, the patient's cost for these treatments is not tied to the cost of the drug. Most patients pay nothing. Thus, any savings produced by the consolidation of treatments goes to the provider. Your situation seems to be different, although I still don't understand the rules of your coverage. If your cost is tied to the provider's cost, then perhaps you can save money by getting treated at a center that is able to treat many patients on the same day.
Best wishes,
Larry
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LarryD - Name: Larry D'Addario
- Who do you know with myeloma?: wife
- When were you/they diagnosed?: September 2012
- Age at diagnosis: 65
Re: Additional out-of-pocket expense for treatment
Does anyone have any info on help with doctor copays?
My husband now has lung cancer & I was diagnosed just 2 months ago with multiple myeloma & when we go to the oncologist for treatment we have 2 copays of $40.00 each. This adds up, but I can't find anything on the website for help with doctor copays.
Thanks for any info.
My husband now has lung cancer & I was diagnosed just 2 months ago with multiple myeloma & when we go to the oncologist for treatment we have 2 copays of $40.00 each. This adds up, but I can't find anything on the website for help with doctor copays.
Thanks for any info.
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barbara1200 - Name: barb
- Who do you know with myeloma?: myself
- When were you/they diagnosed?: 2013
- Age at diagnosis: 75
Re: Additional out-of-pocket expense for treatment
Barbara,
Regarding copay payment assistance:
Suggest you look into Leukemia & Lymphoma Society. They cover up to $10K in expenses.
The Chronic Disease Fund (CDF) can also help.
You can also contact the multiple myeloma drug manufacturers such as Celgene, as they also have financial assistance programs.
Regarding copay payment assistance:
Suggest you look into Leukemia & Lymphoma Society. They cover up to $10K in expenses.
The Chronic Disease Fund (CDF) can also help.
You can also contact the multiple myeloma drug manufacturers such as Celgene, as they also have financial assistance programs.
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Multibilly - Name: Multibilly
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: Smoldering, Nov, 2012
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