Hey!
My husband is covered under UHC and a 3mo injection of Lupron is crazy high and the out of pocket we pay is also very high. I’m in the process of researching Orgovyxv to use instead, but not sure if insurance covers it.
Thanks for your input!
how do you afford Lupron and other ca... - Advanced Prostate...
how do you afford Lupron and other cancer drugs…even with insurance coverage?
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Newdiag-NC
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Have no idea what i pay. Cancer center has me on a reasonable payment plan. My balance stays about 5K. I have tried to pay it down in 3 payments and they told me "no, money shouldn't be a burden when you are sick"
What a true Blessing, they are not pushing you to pay!❤️
True compassionate care
I tried the same thing. Orgovyx costs even more. I thought that UHC covered Orgovyx for advanced disease but my Dr. informed me differently. I decided on the 6 month Lupron shot. They charged UHC $56,000 for the single dose. However, UHC then discounted that by $50,000.
Yes, I feel you!!! This may drive us into the poor house with all the other increasing expenses!
After you are broke, then you pay virtually zero, can't work? SS pays squat... so government steps in. It is what we pay taxes for isn't it?
Wow! They seem to be way over charging and then reducing it to make you feel like you got a deal. Doesn't seem like they are trying hard enough but you also have to be aggressive in pursuing discounted co-pays. There are often drug manufacture co-pay assistance programs but you have to ask and check on their websites.
Good luck.
I am not responsible for all that was charged. I do have United Healthcare and my maximum annual out-of-pocket is $5,500.
Medicare, Obama care and United. I don't know how people can work with bone mets. then again most are probably not in the Trades.
The drug manufacturers post ridiculous "sticker" prices for drugs. This is to make you feel your insurance company is doing something great for you. There was a fairly recent article about this for Lupron. Mentioned how ridiculous the prices were for these very old drugs
I searched Google for " high costs for old drugs Lupron" and and article about "$38,398 for a very old cancer drug" appeared.
Another article I read described how I believe some of this is to show a imaginary paper loss by hospitals that they can then apply towards their required community help as part of being a non profit business. It all a big fraud. Hospitals had two sets of books so to speak. One to show a loss for meeting their community help requirements ( which most hospitals never come close to meeting for the most part) and another for actual costs. Just a fraud game.
Google for yourself
My research online is that the actual cost to hospitals is around $8k - $12k. Depending on your insurance and whether you have fulfilled your cap expensive amount for the year, there will be a co-pay but should be far less than what is beeing charged. The cost will also depend on the dosage (i.e. every 3 months, six month or 12 months).
Eligard is less expensive but equivalent to Lupron. Here is a link for a manufacturer's discount eligardhcp.com/coverage-rei.... I am not sure how this applies but may be worth checking into.
If you look at your EOB you'll see the list price, and what the insurance company paid. So I received Lupron injections at three different hospitals in the same year. All in different states, w ith the same PPO insurance through BCBS.The list prices and what each hospital was paid varied greatly. Two listed the cost of Lupron 3 month as about $2400 $2500 the received $1500 and $1700 for the injection. The third listed it as like $10,000 and received about $5000.
My insurance broker explained why a hospital may charge higher prices. Simply because they want to be paid more. So they tell BCBS this, BCBS then marks up the BCBS health insurance plan cost for that hospital to offset it.
So that hospitals BCBS insurance policy costs about twice the other big hospital in town plan cost. The hospital get more income, BCBS facilitates that, and keeps the hospital's business. The government and the patients pay for the arrangement.
No pricing of drugs based on actual costs, it one hand washing the other. It's how healthcare is done in the good old USA.
just insane and it continues on..
How old is he? It is fully covered by medicare+supplemental.
He’s 70 but still working, using work insurance. Thanks for your help!
If you have commercial insurance (through work or personal), most of the drug companies offer co-pay assistance for socially drugs.
For example I have $0 co-pay for NUBEQA and Xtandi and Xgeva. Though I only take NUBEQA.
I have UHC. I don’t remember what my 6-month Elligard cost, but the co-pay wasn’t much. I never looked into co-pay options for it.
very helpful! Thank you!
I'm always suspicious of these mentioned assistance programs. I wonder just how many people would actually receive assistance and how your income and assets would affect ability to receive meaningful assistance.
That’s a shame you’re suspicious. The programs are real if you have COMMERCIAL insurance whether you pay for it or your employer does. Medicare or other government insurance NOT ELIGIBLE.
I have six figure income and have qualified for multiple drugs. I have insurance that is managed by UHC at this time but was Aetna for several years also.
My cancer and other specialty drugs come from CVS Specialty with a $250 per month copay.
I have saved at least $15,000 in copay assistance from Gilead the maker of two different drugs I’ve used. I’ve also already saved $500 on my first two months of NUBEQA.
Minimal effort to apply online and minimal information requested. It was my doctor who told me about Gilead programs, but now I check for all specialty drugs. I already had a $0 copay from Bayer for NUBEQA, but the CVS Specialty Nurse suggested I apply for assistance.
There’s little downside to a manufacturer doing this. Many patients would not pay that much for a drug, so waive the co-pay and at least pickup the insurance pay amount. That’s better than no customer.
If I were you I would be going on Medicare plus I supplemental policy. I have been using Medicare for cancer treatments for the last 6 years. All I have paid is my $185 deductible per year. All my cancer treatments have been covered by Medicare and my supplemental at no charge to me.
This sounds great! Sounds like you make the right decision buying the expensive insurance! I’m so glad for you!
I hoped this day would never come but I’m glad I’m mostly covered now.
❤️❤️❤️
check out
TAFCares.org
Or PAN Foundation
Hope that one of these can help you with the high copays. (Both are legitimate)
Thanks! I’ll check them out!
I believe Eligard, which has the same active ingredient (leuprolide) as Lupron but a different delivery mode, is quite a bit cheaper than Lupron. Perhaps there are other brands of leuprolide, too?
Zolodex, a different drug (goserelin) that does the same thing, is also generally less expensive. Same with Firmagon (degarelix), which is a drug similar to Orgovyxv but is injected (and hurts like a bastard for a few days!).
Cost also depends on your provider, too. It's a great system we have here in the USA, lol. As noted in a post here when the story came out, NPR recently did a story on not only how the maker of Lupron was ripping customers off, but on how some providers LIKE being ripped off, because the high price of Lupron allows them to more greatly rip off insurers and patients. Here is the example given:
"Medical service: Two three-month Lupron Depot injections for metastatic prostate cancer.
Service provider: University of Chicago Medicine, a 900-physician nonprofit system. [nonprofit... really?!]
Total bill: $73,812 for the two shots ($35,414 for the first, $38,398 for the second), including lab work and physician charges. United Healthcare's negotiated rate for the two shots plus associated fees was $27,568, of which the insurer paid $19,567. After more than a year of haggling with the hospital and insurer, [the patient's] share of the bills for the shots was determined to be nearly $7,000."
Ugh.
It’s making me nuts…
Thank you for all this information! I saw that NPR article, the price in the UK for a dose of Lupron (listed as pill or unit) is $263.75 (pharmacychecker.com) 3.75mg. Heartbreaking and criminal 😞
It might be time to switch to Medicare. I am on Original Medicare with a supplemental plan. Medicare pays $334 and I/supplemental plan pay $84 every 3 months for an Eligard injection.
Thank you!
Medicare covers a lupron injection 100%. Time to talk to an insurance expert and start using work insurance as a secondary pay.
Headed for a consult…thank you!
What is your annual max out of pocket? We have been on Medicare since April, but the year prior my husband never paid anything for either his monthly degarelix or Orgovyx after he switched.
While on commercial insurance, there is a manufacturer’s copay card that brings the cost down to, I believe, $10. We have been fortunate that my former employer insurance covers Orgovyx for free.
We did start Medicare in April 2022, when I retired. We are still on my employer insurance until 2025, but there is only a 6 month open enrollment window when you first start Medicare, and can get a supplement with no underwriting. Knowing we would never pass underwriting, and knowing that we wanted a supplement and not an advantage plan, we started our supplement on October 1. So now we have a ton of insurance but also great peace of mind and our maximum out of pocket annually is only $233.
Thank you! That peace of mind is priceless!
Max out of pocket for us is $5k. I’ve got a lot to learn!
If I can help in anyway, let me know. I am far from an expert but I did a lot of research before making our own Medicare decision. That’s a pretty hefty OOP.
Thank you! Right now I’m googling, reading about Medicare and will check out those copay cards. I plan to make an appointment with a local insurance expert. Feel free to send any helpful websites my way!❤️
Again, thank you!
When talking to the local insurance expert - they're likely to push a Medicare Advantage plan.
The reason for that is simple - if they sign you up for an MA plan - they get over $600 annually for as long as you stay in that plan. It's in their self-interest to sign you up.. even though the vast majority of people here have found standard Medicare with a Plan F or G supplement provides much better coverage at an overall lower cost.
Another small fact on MA plans - there is an excellent article by the National Retiree Legislative Network (nrln.org/) about Medicare advantage and why politicians are pushing Medicare to support it - it's called lobbyists and insurance company profits. The article can be found at: nrln.org/presidents-forum-1...
The profits and government payments the Medicare Advantage companies are raking in are obscene. They're one of the best arguments for a not-for-profit single-payer system.
@TJGuy said it already - "Never ever go on Medicare advantage plans".. there's a reason all those commercials hit around September (open-enrollment period) - and the reason is profiting off health-care.
Thanks for this information. It feels like this whole scenario is filled with traps the unknowing will fall into😞
Never ever go on Medicare advantage plans. Stick with regular Medicare, don't listen to those commercials on TV
Time to get on Medicare A and B, plus a supplemental, plus part D for medications. They cover my quarterly Eligard shots, and semi-annual Prolia. However, started daily NUBEQA, costs nearly $14,000 per month before Medicare..........which takes the monthly cost down to $1,500 before I navigate through the Part D doughnut hole.
NUBEQA is free if you have commercial insurance. But the program is not available to any Medicare recipients.
I was on Zolodex , three month implant here in Europe. My cost was 216.00 euros. Converted to USD, under $224.00
My radiation treatments, 44, would have cost over $100,000.00 in US. Here 8000.00 euros
Too many more similar stories
Oh my GOSH!!!! Well, thanks for answering and I’m so glad it’s much better priced there! Hope all your treatments are healing and successful!
For anyone under medicare age- My husband is 54 and self employed. His cancer center pharmacy is fabulous with working with us and our insurance. But we just know we are going to have to pay our family's (5 of us) max out of pocket each year. So I shop the ACA each year for plans that cover our drugs and doctors (for our daughter's Crohn's too). I also shop for plans that have a max out of pocket/premium ratio that is best for us. This year our family max out of pocket is $17,000. We hit that by February each year due to both my husband and daughter's meds. We did get a tax break from ACA this year so we pay $1800/month premium instead of $2500. The good thing (as opposed to a plan thru a job) that I can 'shop' plans to choose for our needs. I'm looking forward to medicare. I always get concerned that I don't know what treatments his oncologists may suggest each year- so maybe what I choose for insurance won't cover that. Or, if the day comes, that my husband can't work- since he makes the bulk of our income. We will need enough in the bank for the required time to go by before we can apply for medicare (you can apply young after a pd of not being able to work medically- different than medicaid. But I don't know income/savings caps to get that.) It's all SO confusing and a crazy system.
You sound like an expert! And insurance shopping is time consuming I’m sure! But what choice do we have? My heart goes out to you and your family. Praying healing for your husband and daughter ❤️
Thank you! Daughter diagnosed 2014, Husband 2017. (He went from employee to self employed 8 mos prior to his diagnosis- ugh!) So I'm an expert out of necessity. It's my full time job on top of my part time job. Lol. My parents moved in with us in 2018 so my mom has been explaining Medicare to me- we talk insurance issues a lot!
I have UHC and pay $72.30 per month copay for Orgovyx. I’m on the Medicare version of UHC,
Thanks!
Never go on a medicare advantage plan. Always stick with regular Medicare. Google "Medicare advantage warning"
Mine is fully covered in my health plan. Virtually all health plans cover 100% injections given at a doctor's office/ medical facility. You need to research on this with your policy.
Add to that Lupron is available as a generic, look into that. Sadly I believe even the generic is expensive. Also longer acting doses may help reduce the costs, ask your doctor. I believe you can get up to six month treatments, which helps in many ways.
And this is why we need universal health covererege in the USA!
Thanks for your reply! Yes, we desperately need radical reform. I hate to think of people who suffer and die from not being able to afford healthcare.
In Ireland, where I am the public drugs scheme provides all family medications for a $80 a month cap. This includes all my ADT drugs, and all my chemo drugs such as neulasta plus my ED drugs and injections. Not sure how it works in the US if you don't have insurance but the system here is really simple and has saved me a fortune in drugs costs.
Yea, I have (in the USA) a veteran's benefit which is full health care. I pay nothing for anything, which is the way it should be. Also in the USA is something called Medicare which with co-insurance (which is easy to get) can result in the patient paying nothing.
But for many (most?) people the costs of health care are astronomical and so many either lose everything, or go bankrupt.
Sad!
NEHOG, thank you for your service, glad you’re provided for! You are so right..
OzzieJ, thanks for replying! You are fortunate to have this provision! It seems like many needy US patients’ wallets are emptied into drug manufacturers’. I’m in AWE of what you have. Hope these treatments are curing you.
If you haven't already, check out
uhc.com/medicare/medicare-e...
Toward the bottom of the page, there's an FAQ about Medicare while still working after 65.
Thanks!
I have a Medicare Advantage PPO plan. I pay $124 for a 3 month Lupron injection.
Wow! Thanks for your reply!
Never go on a medicare advantage plan. Never. Google " Medicare advantage warning"
Agree. I just had a family me.ber denied scans. The receptionists at 2 offices told him it's Medicare advantage- which is not Medicare. It's private insurance and doesn't approve many things.
WOAH!
Would not have known, thanks!
Primary is Medicare. Supplement is BCBS. Rx coverage is Humana. Humana costs about $320/year each. BCBS is $1500/6 months each. We have nothing above the premiums which we feel is well worth every penny.
That sounds like great coverage! Thanks!
we all have varying degree of insurance coverage and as a result a lot of people opt out of full coverage upfront. Before I took Medicare and Supplemental, I had UHC. Since the injections of Lupron or Eligard was in a hospital clinic setting, I paid nothing for the 6 1/2 years I received outside of annual deductible for medical care. My understanding should I have to go back on ADT, I would still be covered, but with a larger annual deductible.
I guess my point is and I may be all wet, but it makes a high difference as to who and where you get your injections and well as what healthcare plan you are paying for.
For example, if I had had my injection in a doctors’ office, my coverage would be less than having them through my medical oncologist in a hospital cancer center. As I was told my my Radiation Oncologist in May 2004, any physician can DX Lupron and give injections, it’s where you receive is the factor affecting cost.
My rambling writings are antidotal to me; just as everyone else. Please investigate and read where is the best coverage offered by your plan. At 70, it would be good to evaluate the company’s plan vs Medicare and a solid Supplemental Plan. BTW, my supplemental is the same company as my company plan… UHC. I note that I also pay about twice what I paid in 2011 before I went on Medicare and UHC Supplemental. Good luck as this is confusing. I suggest that you contact and sit down with a UHC specialist…. Ours came to the house…. And have them compare and give options.
GD
Newdiag-NC in reply to
Very helpful information, thanks! So much of this I had no clue about.
Similar to these other replies, I'm on Medicare plus a no premium HMO supplemental plan, and my leuprolide acetate (Eligard) 6 month injections only cost me $275 a couple years ago. Plus the nurse's act of administering the shot was free for me! 😁 🦊
Sounds like you have great coverage! Thank you for your help, hoping for cure and great long life ahead for you!
Good luck on your insurance coverage decision and in your husband's bout with this crummy disease. 🦊
Thank you!
Hi - we have private coverage through my husband's employer. We meet our high deductible and out of pocket in the first 10 days of every year. It's been almost 4 years of this horrible disease. The cost of some of the hospital administered drugs are very expensive. I know we have spent millions of dollars to keep him alive. I'm just thankful he woke up this morning. He made it to another month. He will be 63 in May. I hope your husband can find a drug that works for him and keeps the cancer under control.
Thank you for your input. It doesn’t take us long to meet that high deductible either. You’re right, every day we have with our warriors is priceless. Wish they didn’t have to suffer so much. Hugs for you as you hurt along with him. Sounds like you’re a great support ❤️
Do what you can and try your very best. We consult with several different oncologists from various hospitals for 2nd and 3rd opinions all the time. I think that gives us some peace of mind. 💙
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