Still waiting for the hospital to settle the first Pluvicto treatment. Have to admit that I was shocked to see the charge before our insurance covers the cost for Pluvicto. For those that have had the treatment - How much did your insurance cover? I thought the treatment would be in the range of 50K per treatment. Thank you.
Pluvicto- cost per treatment ? $162,... - Advanced Prostate...
Pluvicto- cost per treatment ? $162,067.80
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NotAlwaysSunshine
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I don’t know why no one has responded. My husband has had 3 treatments and I haven’t seen a bill yet. I will look again but there was some cost discussion on here several months ago.
Thanks - We won't see a bill because we meet our out of pocket January 1st every year. I just don't want my husband to fall off the edge if there is some sort of dispute on the claim. His next treatment is 11/4 depending on all of his blood counts. Hope Grumpy improves today!
I know the insurance companies negotiate tremendous discounts with the providers. I was charged $56,000 for a single 6 month shot of Lupron. My insurance received a $53,000 discount for a net reimbursement of $3,000. The Pluvicto charge seems outrageous. I spent 33 years working as a nuclear pharmacist. During this time, I dispensed many Metastron (Sr-89 indicated for palliative aPc). These single dose vials cost the dispensing provider a few thousand dollars each. What a rip off.
The $162,067.80 is probably from the hospital's so-called chargemaster. This amount is much more than insurance company negotiated amounts for the same service (as previously pointed) and the amount that uninsured people pay is almost less too. An unnecessary antiquated system IMO
Our insurance has covered 100%. I would need to add up all the charges including post treatment bio distribution scans etc to get you a total per treatment.
This is what was approved at Mayo Clinic for my husband. He has had 3 treatments so far.
Medicare-approved amount
$162,211.50
Medicare paid
$37,626.78
His secondary insurance will pay 9,554
Thank you - that is response I was looking for. The Medicare approved amount. Our insurance will most likely approve 50K - Thank you so much!
Was that the PPO Medicare or Medicare Advantage HMO ?
Can I please ask what is for me the bottom line? How much, after any and all insurance, was left to pay out of your own pocket?
Frankly, I’ve been losing sleep over this question. I have Medicare and Humana secondary, but can’t seem to find any ballparks of how much people are needing to pay out of pocket after everything else.
Thanks very much.
Medicare and secondary insurance covered it all. Paid nothing out of pocket. Note, secondary did have deductible, but that had already been met.
We meet our deductible the first week of January every year... Yes, our insurance covered the cost. My point was that the total expense was crazy.
It took about 2 months for Mayo to code and bill Medicare, but now it's been paid and medicare approves it in a timely manner.
Thank you - I think we are the 10th patient at Ohio State to receive Pluvicto. In general, claims payments have been slow due to who knows why??? I'm going to guess it will be 2 months before the claim is adjusted and paid. I hope your husband is doing well in his 2nd go around with "Pluto" treatment. What a roller coaster!
The coding process took the most time. I'm sure Mayo knew what they were doing and it took 2 months before they submitted claim for the 1st treatment.
My husband has had 3 treatments of pluvicto to date. This is his 2nd time around with Lut-177, first time was in the vision trial. Pluvicto isn't going as well as it did in Vision trial. He was in worse shape when he started Pluvicto, low platelets and alot more mets. Dr has fought real hard to get his 2nd and 3rd treatment as his platelets were lower than allowed for treatment. New mets have shown up after 2nd treatment. So, will see if he is allowed to continue.
in reply to CJ4J
I imagine it will take some time to get the billings worked out. I had heard at one point during my managed access trial this year that 1 treatment of Lu177 was going to be $80K+. That’s of course before negotiated rates take that amount down quite a bit.
I’m sorry things are not going as well with your husband’s Pluvicto this time. The managed access program allowed trial access earlier this year to the drug part only for up to six treatments until FDA approval. After two treatments, I was not getting a reduction in PSA and instead large increases in PSA. We debated on continuing with 3rd treatment, but went ahead with the treatment. 3rd treatment resulted in continued rising of PSA and scans indicating mets more widespread than before starting. In addition, Hemoglobin and Platelet counts declined significantly since starting and I now have limited my access to any other treatments.
CJ4J in reply to
Are you getting your Pluvicto at Mayo as well? Sorry to hear it's not working for you. Have you had genetic testing? Dr Kwon has repeated the guardant test every few months for my husband. The 6th test showed a new mutation which opens up the door for another treatment.
in reply to CJ4J
I was getting Pluvicto in Chicago though Dr Kwon was my main doctor. Mayo was not included in the managed access program. I have had genetic testing twice, which now indicates I may be eligible for another treatment. Also, trying some different chemos that are considered less toxic to the blood system.
NotAlwaysSunshine in reply to
How are you feeling now, HD? We are also worrying about the Platelet counts.
in reply to NotAlwaysSunshine
I am trying to get blood levels up through blood and platelet transfusion as well as fight the cancer with chemos or other treatments not as toxic to the blood levels. One day at a time.
ajok in reply to
Did anyone try to explain WHY your PSA would continue to rise? I mean, the little radioactive particles are supposed to kill the cancer cells, not fertilize them!
I’m supposed to start Pluvicto in a few weeks, and your report is not giving me warm fuzzies.
HDGuy61 passed away in December. He was my guy. Pluvicto was his final try before blood numbers got too bad. If youve had a PSMA scan and FDG scan that show you are a good candidate, I’d say go for it. If you are unsure if you’ve had an FDG scan as well, I’d personally ask for one. Pluvicto only kills the PSMA+ cancer. If you have a lot of non PSMA cancer, LU177 can make things worse. He believed that is what happened to him. Many docs here in the US do not do both scans but in other countries where that have had more experience w the drug, they do both to determine if you are a good candidate. I’m not an expert, if you have questions, I’d make your own post regarding your details and history. These men here are very helpful and much more knowledgeable than me. Best wishes to you in your journey!
If you are wondering if that is a rip off price. The answer is yes. This is proven by the private pay costs for the many patients who travel to other countries and self pay for Lu-PSMA treatments at respected and legitimate for-profit centers in Germany, Australia, India, Finland and England. These typically charge $10,000 to $12,000 US Dollars per treatment cycle. Equivalent local currencies. I paid US $ 11,000 combined for both my two Lu-PSMA-J591 treatments at GenesisCare AU in Perth.
Under the current US system, use of the word "price"no longer makes economic sense, since listed prices for drugs and procedures often give little or no indication of the actual combined costs incurred by the patient and his third-party-payer(s).
Imagine if auto insurance worked in ways analogous to our healthcare system. A car-owner's share of payment for an oil change might be between $1 and $1000 while his third-party-payer's share might between $1 and $1000, depending on terms of coverage, and on whether the procedure was "automotive-ly necessary," and on the credentials and affiliations of the firm or individual hired to do the procedure, etc. The list "price" becomes a meaningless and arbitrary number bearing no relation to final costs paid.
Why would an oil change ever cost as much as $1000, you might wonder? Because when things are paid for with Other People's Money, in part or in whole, the price mechanism of market-based supply and demand breaks down completely.
From a cost perspective, our hybrid of private and socialized healthcare is worse than either "extreme" of just one or the other, because under such a system the incentives to cut costs are either compromised or broken altogether. Incentives are merely to SHIFT costs.
I have just today had my first Lutetium treatment at St Vincent’s hospital in Sydney, Australia. Total cost is A$5,500.
That seems about right in Asia. Not sure about UK
These examples could contribute to eliminating any wonder on why, 50 years after the POTUS declared War on Cancer (Nixon), that today, the paradigm of therapy is treating it more akin to a chronic condition, than to go all out for a cure! Memorialized by recent financial guidance that very fact, that treating cancer as a chronic condition was financially prudent for the medical community. Financial Toxicity is a term, and a real life side effect of diagnosis... Adding to the fatigue a patient experiences in addition to trying to navigate the mine field of diagnosis, treatment, lifestyle, and so much more. It's terrible that it is an often overlooked paradigm. Is little wonder then how those who live in top tier affluence tend to also have long lives (ability to pay)...
I can't remember which financial institution gave that guidance, sorry for lack of reference.
Anyways...
Best Regards
well summarized. Thanks CO.
Gosh, $50K per treatment? Wow, that is obscene. I have United Healthcare insurance but did not use it for treatment, only the diagnostic work. In 2020, I received LU-177 treatment in New Delhi, India since it wasn't FDA-approved in the US yet for early-use therapy. The cost was approximately $6,000 US dollars per infusion and I had 3. I got to work with Dr. Ishita Sen, a first-rate doctor (who I love and adore) with lots of years of experience with this medication.
Very interesting in the prices differences. Novartis sets the pricing. Pricing should be the same no matter the country.
Lu177 PSMA therapy available at more than 20 hospitals in India at different prices . Private hospitals and centres charge from 4000-6000 dollar approx. They donot use pluvicto and label the Lu117 themselves. In government hospitals like AIIMS the charges are much lesser, only few thousand rupee and they have best experts. At Tata hospital in Mumbai, which has biggest cancer setup it would cost only about 1000 -1100 dollars for a cycle. We went for aiims.
Just a piece of data for this discussion: Novartis sets the wholesale price for Pluvicto at $42,500 per dose. Of course the hospital has to get paid to have facilities for handling it, and for administering the dose, but it looks like the overall charge was a little less than 4x the wholesale price.
In India the price is approx 5500 pr treatment
patient_india in reply to
Price in India per cycle ranges between 1000 dollars to 6000 dollars depending on setup. The centres with best doctors and maximum experience and research are government ones like AIIMS but very busy. around 15-20 or more private centres also doing PSMA therapy in India and more coming up but very few have doctors trained in these.
in reply to patient_india
I understand Fort Memorial with Dr Ishita Sen is a very good choice.
patient_india in reply to
Centres having doctors trained in these therapies are ideal. All these are new and upcoming treatments, lot of research is on.
AIIMS team leads in patient load, have published lot of research papers as well as have training program in therapy.
India is anyway becoming hub of medical toursim. Jaslok hospital, HCG hospital all have much senior fantastic therapy doctors but are costly for Indians.
Minimum hospital mark up I saw on hardware and drugs during my medical career was 100%. Professionally (professional fees are separate from hospital fees) if you are out of network i.e. not contracted with an insurer you can actually bill whatever you want. I have reviewed bills from New York charging $100,000 for a trigger finger release. The motivation for this is to an extent greed but also the fact the the more you bill the more you get eventually when the dust settles and you finally get paid. So if you knew that for a given procedure say BC/BS paid $$$ and you just billed $$$ it is highly likely you would be paid $$ whereas if you billed $$$$$ you might get $$$ or possibly $$$$. Medical care in the USA is so in need of reform on so many levels but there is so much lobby money around I doubt it will ever happen in any form.
The actual cost for Pluvicto that was billed to our insurance was $116,503.13.
That amount insane, no wonder people are just giving up that does not have insurance, so sad in this world since cancer is on the rise of all types. When getting my infusions (2nd time around since 2018) the ages is getting younger, makes you wonder what we are doing wrong. Is it the environment, food additives or all the waves of electronics. I think we will eventually kill the earth and us many years from now, glad I will not see that in this life.
We blame genetics. Wondering how it all started, as you do.
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