I have been on Xgeva for 3 months & my insurance is being charged $10,635 per month, of which they are paying $10,200. It is a monthly injection.
I talked to a Walgreens Pharmacy employee and he said the cash value of Xgeva is $3,200. Seems like a heck of a markup. Any ideas?
Answer: It's because you live in the USA where our government doesn't negotiate much with Big Pharma. Here's what they paid in Canada in 2016 annually:
Denosumab (Xgeva) is available as a 120 mg/1.7mL single-use vial of solution for injection at a cost of $575.55 per vial (Ontario Drug Benefit Exceptional Access Formulary, October 2015).1 At the recommended dose of 120 mg/1.7mL every four weeks, the annual cost of denosumab is $7,482.
ncbi.nlm.nih.gov/books/NBK4...
If I have time, I'll try to research today's comparative costs among the different countries. Five years ago, my husband's Zytiga charge was $11,000 per month, and the rep tried to bully him into agreeing to one more month's worth even though it was failing!
Thanks!
Another issue is Xgeva does not have a generic. That's part of why it's so expensive.
An equally good substitute is Zometa (an infusion done every 12 weeks). Zometa has a generic (zolendronic acid) and is significantly less expensive.
ncbi.nlm.nih.gov/books/NBK4...
Annual Cost: $2,521 to $3,361
You have to go in for infusions vs a shot, but it's only every 12 weeks.
I could be way out in left field but question. Do you get the Xgeva injection or infusion at the cancer center ? In house like that usually get better insurance coverage. At any rate your coverage ain't so good.
Try Nubeqa at $12,000 a month. Medicare covers all but $500. My state has a assistance program that pay all but $10.00.
Medicare covers my Xgeva quarterly injections 100%.
I am thinking you are taking Prolia or some other generic because, from my understanding it is only monthly?
I pay $555, which I can afford but I don't understand the mark up?
I'm in Canada and cost is $750 monthly. Drug isn't covered by our National Health Plan. I have private insurance so pay $150 monthly.
Fortunately I live in Australia where thanks to our Universal Health Care, Xgeva is prescribed at a cost of A$43 for a months supply, however because I am a Senior, the cost is reduced to A$6.40, and because we have a “safety net” feature which means that after you have expended a certain amount all scrips are free.
This forum is predominantly American, and our US colleagues are at least one more Jan 6 event away from recognising that their versions of government and personal freedom make it near impossible for government to negotiate fair pricing for just about anything. A topic best avoided….
Too late for me as I've already put "both feet" into it regarding medication costs on another thread. In my defence I made my post in genuine astonishment at the personal costs our US brothers have to pay for similar cancer medications that I get for a nominal amount here in WA. Pity I didn't see your post beforehand!
We could have what Australia has. But we in the US are way more into war works programs. The “Majority” politicians and citizens really like leaders who like the saying freedom isn’t free. So with that mindset we are stuck with high costs for medical care. Cheers 🍻 Bud Zero 🙂
Hey my neighbor works for Boeing and does well and helps the county pay it's taxes!👍
Worked for a major Casino corporation in Las Vegas and we had a few that visited the properties that worked at Boeing, and Lockheed and they helped with the tax base in Nevada also. That trickle down economy does work. The problem is government always spends more than they take in and this country as do many have great debt that can’t and never will be paid because of just the math. Yes we could have what Australia has but it would be more debt that can’t ever be paid on our current tax base. It’s our thirst for policies that live off the giant credit card in the sky. It’s based on Keynesian economics. Now don’t get me started! 😆 Cheers 🍻 Bud Zero.
I live just West of St. Louis, in a small town, and another neighbor works for McDonald Douglas. St. Louis has them all, including Ratheyon, I think? It's worth it to them to drive quite a ways to work.
The US government is nothing but a piggy bank for big pharma.
Us Americans need to vote for people who will bring single payer healthcare. The Pharma companies want to stay on their Corporate Welfare supported by American Taxpayers and sick people. GO out and talk about this on social media and write your representatives. Don't let anyone silence you by saying this is "political". Everything is political, including your health.
We've always had trouble distinguishing large anti-competitive big business (and anti-competitive professions as well, btw) from the corner convenience store with hundreds of competitors.
No way.
de-luke: " Everything is political, including your health." I don't know if everything is "political", but morally, medications to keep us alive certainly could becme political.
Xgeva was part of my ADT treatment for about two years. It cost me about (round #'s) $500/mo. (20%). Insurance covered about $2000/mo. (80%). ADT is categorized as "Therapy". Like Radiation Therapy, which also cost me 20% at the time. My insurance company (BCBS) appears to negotiate prices with providers of services and pharmaceuticals per the summary statements I see regularly. It's a State by State thing in the U.S., I believe.
I am paying $555/month but I don't understand how I could buy it for cash at $3200 at Walgreens, when it starts out at 10K?
I looked at the Formulary for 2022. Xgeva is listed as a Tier 5 drug. Where I live it is not available in local pharmacies. It is only available from a national distribution company. I received a monthly subcutaneous injection at my urologist's office, as I said, for two years before it was deleted from my treatment. (Eligard twice per year; also subcutaneous. That treatment continues.)
Greed
When Profit Is a dirty word.Big Pharma is the problem along with insurance. Fixed system.
My medicare pays for 6 month injection in my Dr office. I pay nothing. I skipped my last shot because my dexascan was greatly improved. ( worked out more & lifted weights)
I think you are getting Prolia because Xgeva is a monthly injection?
Can't get your link to work?
It works now. So, in 2020 it was $2352 and the price I got from Walgreens of $3,200 sounds about right, today. So, there seems to be quite a "markup", even though it is a Tier 5 drug. Thanks!
I had my monthly injection two days ago. The oncology office charged $4,200 for the injection of denosumab, 1mg. My Medicare Advantage insurance paid $2,545.20. The oncology office also charged $50 to do the injection and insurance paid $13.43. I owe nothing.
Sounds great but those charges are a lot less than my insurance co. is being charged?
You should try your hospitals pharmacy.I just got a call today from MGH pharmacy and they found a grant for me that will cost me $0 for Nubeqa. As much as i hate big money in politics there are some grants out there and some very caring institutions.
I got a little bit of grant money for my Erleada but my investment income (if it lasts under this administration) was too great last year for any more?
Yes it’s sad you work your whole life saving for retirement and then you get dx, then you start drawing on your retirement and now your drugs eat it all up. I always questioned taking a decent percentage of my payday to sock it away for when i retire and not having that extra money for present day expenses, vacations, toys etc
The key to investing the stock market is buy stocks of good companies and hold and don't sell in the downturns, because they will come back unless they their doors. Vanguard is the best because they started ETF's which are a combination of many companies to fall back on as the stock market goes up and down.
Thanks for that link, saves me the Google search! MO plans to put me on xgeva next month after my ct guided deep bone biopsy (right acetabulum).
I’ve been signing up for all these copay assistance programs for every drug that’s been in the discussion for me.
Not complaining that these exist, but it just proves in my mind that the drug companies want to milk every penny out of insurance without losing patients (customers) due to high copays.
We want free enterprise (at least I do) & drug companies experience a lot of R&D costs for drugs they develop. But I don't know if that is in play here or not? If it becomes "generic", maybe that will help?
My PSA dropped to 0.1, over the past 5 months, from 7.3 & if it stays at this level, I may go to every 3 month injections? So, that will help, also. But I can't get a straight answer on why it is so expensive.
At my last injection the nurse asked me to warm the drug bottle with my hands, because hers were cold, & I was shocked as to how small it was. It is definitely worth it's weight in gold!
Thanks for the info!
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