G68-psma and Insurace

[StayingOptimistic]

Hello everyone,

Does anyone knows if the g68-psma is covered by Insurace. I have a very good plan through my wife’s company and not sure if it’s covered.

I would appreciate your experience with this

Thank you

[tango65]

No it is not approved by the FDA. It cost 2700 at UCLA.

[MichaelDD]

I just did a clinical trial at UCSF in October. No insurance coverage (Anthem Blue Cross) at this time. UCSF is resubmitting now that results are postitive and no other scans ( body/bone) showed anything.. My highest out of pocket is $3200- lowest if anything accepted by insurance and paid $800/ . You call UCSF Radiology Billing (or the facility you are considering ) and ask for the CPT codes . Get those and then submit to insurance for a quote.

[ctarleton in reply to MichaelDD]

UCSF Radiology Billing:

Billing & Insurance

[phone]

Monday - Friday

7:00 a.m. - 4:00 p.m.

Reference:

radiology.ucsf.edu/patient-...

[StayingOptimistic in reply to MichaelDD]

Thanks, Michael

I live in NY. what is your current psa?

[MichaelDD in reply to StayingOptimistic]

June of 2016 .042- November 2018 its 1.99 . Fast doubling (4 to 6 months) but low PSA numbers. I had no lymph or bone met involvement. Multiple nodules (more then 10) both lungs. All 3 bone scans at local facility couldn't see/ find this. All came back clear. GA68-PSMA found . Very prominent.

[StayingOptimistic in reply to MichaelDD]

Michael, what are your plans for next actions?

Did your MO recommend anything?were you ever on ADT?

Thanks

[Break60]

I just did PSMA at UCSF . The scan itself is covered by Medicare. The tracer is not but only costs $875. Not sure about private insurance coverage.

[Hidden]

I had the scan at UCSF in 2016 - at that time my employer blue cross covered scan but at first rejected tracer because experimental. I appealed and they ended up covering the tracer too.

Good luck!

[Paphman]

I did a clinical trial scan at Nat. Institute of Health two years ago. Included both G68 PET and pelvic MRI. The folks there were great. All at no cost and no insurance involved. Found retroperitoneal lymph node mets. Done because of rising PSA a year and a half after prostatectomy and adt. Go to clinicaltrials.gov and there are a ton of recruiting trials on it if you do a search. Hope this helps.