Lupron Cost Increase?

[inHishand]

My husband had his 6-month Lupron injection in March and the price charged to insurance (BCBS supplement and Medicare) was $27,894, 150% increase in six months! BCBS doesn’t seem to care what they are billed; medical billing is clueless, claim they bill what urologist group keys in system. No one can explain the increase; did get an email from some clerk who advised, “the price has went up”...(no one learns English grammar anymore). Has anyone else seen such an increase? Can’t find news of any online.

[Drcrunch]

It is a big game that they play with medicare. The could bill one million dollars and Medicare will only pay the allowable. The game is that they the know that if they bill high on a consistent basis, they will influence the average charges for next year.

[AlanMeyer in reply to Drcrunch]

On the one hand, it's a game between the pharma company and the insurers. I doubt if BCBS will pay $27K and may, in fact, only pay a fraction of that. But the uninsured patient is totally screwed because he'll get the $27K bill also. Even if the patient is insured, he may be screwed by a deductible.

The doctor and/or hospital may be part of the scam here. Searching the Internet for prices on Lupron I found a price list at: drugs.com/price-guide/lupro...

They're showing a six months injection kit as "from" $9,715.30. I assume that the additional $18,179 is piled by the others on top of the pharma price.

This web page: mskcc.org/sites/default/fil... says that Lupron cost $206/month when it was first approved by the FDA in 1998. Multiply that by six and we get $1,236.

I don't know of any way to figure out what a fair price should be. The cost of manufacturing is probably a small part of the total cost and, in any case, the drug companies never reveal their manufacturing, regulatory, research, and other costs. Legally, they don't have to tell anyone and they can charge anything they want. After all, it's a free market. The dying cancer patient is perfectly free to not buy the drug if he thinks it's too expensive. Ain't American healthcare wonderful?

Alan

[inHishand in reply to AlanMeyer]

I found the same prices you noted online; I suspect a scam here somewhere. But this is not the first time we have had a billing issue with this reputable medical facility. BCBS/Medicare paid all but $1500; it’s the principle with me...and why didn’t BCBS question this 150% increase? ... Cause they are getting reimbursed from Medicare. Our tax $$ flying out the window. Get this: when we first got billing, husband emailed dr and dr actually called him and apologized and said they would get this corrected...someone on his staff Then responds “the price has went up”.

[Mormon1 in reply to inHishand]

Please clarify was the $1500 a yearly or monthly copay? Thanks

[inHishand in reply to Mormon1]

The $1500 I referred to was the balance owed after copay ($40) and BCBS/Medicare paid.

[monte1111 in reply to Drcrunch]

I always wondered about that. Plan pays only about half of what is billed. Thought it was some kind of crooked, cheating way to pay less taxes. Don't know which system is more crooked and cheating: medical or educational. Add endless wars and the Republic begins to fade. No insurance? Paying cash? Can't afford it? Welcome to the legal system and kiss your ass goodbye.

[inHishand in reply to Drcrunch]

That wasn’t specifically my suspicion, but there is a conspiracy in this.

[Fairwind]

For many men here, having an orchiectomy is the best solution. It's cheap, has no drug side-effects, and it's the most effective form of ADT. In most of the world, it's standard practice. If Hubby is not ready for that, see if the price of Eligard (same product as Lupron) has taken a big jump..

[Hidden in reply to Fairwind]

Agree Fairwind. My hisband had an orchiectomy for this reason and many others. (Blood sugar and BP spiked into danger zone on Lupron but not orchi.) The other reason is what AlanMeyer discusses above. If you are individually insured (as we were) and the insurance co only has Trelstar on their list and it doesn't work, you pay full price for Lupron even though you also pay $20,000+ in premiums. The orchiectomy was a win in many ways.

[LearnAll]

When profits become supreme and take precedence on lives and wellbeing of citizens...it indicates a declining civilization...Please don't call me "socialist" ..I am just an advocate for "social justice" When priorities are messed up...some people have private jets and others die because of unaffordable healthcare...

[whatsinaname]

Eligard 45 mg (six monthly shot) is available in Bombay, India for approx INR 31,000/- That works out to approx US$ 443/- (1 US$ = approx 70 INR).

[jgmcbride]

The price seems to be exhorbitant. Quick search on the web reveals prices so very much less. When I was getting treatment about four of five years ago when I was living in Ecuador the price was a little over $900.00 plus $100 to inject. When I would order the drug at the pharmacy they just couldn't believe that anyone could afford to pay that price for anything. I was reimbursed 100% anyway so I was not directly affected by the price.

[Drcrunch]

My provider, memorial cancer institute, appears every Medicare claim for higher payment.They have a dedicated claim department for this. They claim to be non-profit. Sure!

[Drcrunch]

Appeals every claim. Sorry.

[j-o-h-n]

I bet dollars to donuts that donuts now cost dollars......

Answer: It's called a seven letter word "ROBBERY".

Good Luck, Good Health and Good Humor.

J-o-h-n Sunday 06/30/2019 4:46 PM DST

[inHishand in reply to j-o-h-n]

Have always appreciated your take on things posted here. Must keep our sense of humor in this...and fight on all fronts!

[j-o-h-n in reply to inHishand]

Yes humor.... I have to hand it to both of you..... Enjoy

youtube.com/watch?v=j3MwvG7...(Not working as expected?)

Good Luck, Good Health and Good Humor.

J-o-h-n Sunday 06/30/2019 8:50 PM DST

[inHishand in reply to j-o-h-n]

Thanks, beautiful! Hope changes everything....

[sandbergc9]

Check and double check that the forms were filled out properly ( 1 month shot/ vs 6 month) and sent to the correct provider. My Urologist office persists in charging the wrong plan for one of my treatments. Until I see a bill for $7000 ( $27000 - sill) and call and correct the billing clerk. It's happened twice to me. Months in a row. Finally they send the bill to the correct provider... Just my advice. Oh and the person on the phone is never in the wrong...

[inHishand in reply to sandbergc9]

Thanks to you and all who have responded here...we have had billing

errors in past because someone miscodes some procedure...all that comes with these treatments is debilitating enough; the frustration of dealing with people/organizations who don’t care and/or are incompetent is maddening.

[TJGuy]

A recent investigative story on news in my area showed that hospitals use the nonsense inflated price to show they lost money on Medicare and as such can then receive higher premiums and payments.

most hospitals are non profit so they don't pay taxes and they are supposed to give free and low cost care in return to the community for low income patients.

showing a "loss" helps them avoid do so and most hospitals in my area don't provide anywhere near what they a required to provide.