My 6 Month Lupron cost

No comment!!!

08/07/2023

Leuprolide Acetate injection

Total charge

$33,685.45

Discount

$31,927.45

Plan rate

$1,758.00

Other insurance

$0.00

KP paid

$0.00

Not covered

$0.00

Deductible

$0.00

Copay /

Coinsurance

$351.60

Your share

$351.60

[treedown]

Mine was similar.

[MJCA]

Was Kaiser the facility that administered the Lupron? Was the doctor part of KP?

[Hidden in reply to MJCA]

Yes, and Yes

During the regular 3 month MO visit.

Lupron shot was 3rd 6 month.

[MJCA in reply to Hidden]

Then if nothing has changed, I would think a billing error was made. Contact the doctor. Look at Kaiser’s drug formulary; it should be available to you online. Don’t take it lying down.

[Hidden in reply to MJCA]

I did my homework!!!

Part B Injectable drugs are 20% of preferred $1758.00 price. $351.60 for me.

Part D, Lupron is a Drug Tier 5, the copay of a Tier 5 is 33%

Lupron at Kaiser Pharmacy is $1104.83 which comes to $544.17 for me.

Ironically you can not get Lupron through the pharmacy, it is NOT considered a self-injectable.

I took it in my butt standing up!!!

[MJCA in reply to Hidden]

Good you did your homework. Someone effed up. I have been getting Lupron in my ass over the past 18 years. This round has been the past 5 years.

[Hidden in reply to MJCA]

What have you been paying? Kaiser?

I did not pay last year, the 20% is a new 2023 Medicare thing.

[MJCA in reply to Hidden]

I am just a native Californian. Never been a member of Kaiser. I don’t want my doctor working for my insurance carrier.

[Hidden in reply to MJCA]

Read up on the Kaiser model.

Doctors do not work for Kaiser Health plan.

They are Permanente Medical Groups.

I have absolutely no issues getting any needed treatment.

My MO l made a mistake ordering a PSMA/PET 2 weeks after EBRT. Which I let them do it!! Monday she ordered another three months from now, 1 hour later, nuclear medicine calls and schedules me. Was there an issue with the carrier? No!!!

Last year when I was referred to an (LA Sunset) RO, he set me up with a plan without seeking insurance approval. Another note, in that visit, was my RO, a prostate cancer MO, and an oncological surgeon (as I already had RALP), all discussing my case, and the best treatment plan. They sent me to an MO closer to my home for convenience.

Im in treatment heaven compared to my wife having to wait weeks to months for authorizations, and referral calls from BSBC.

[conagher in reply to MJCA]

18 years and you still have PCa Don't understand why.

[MJCA in reply to conagher]

Because it remained dormant for quite a while; i.e. my PSA was in normal range. It probably spread years ago, bone scans would indicate “shadows”. Last year, a PSMA PET confirmed metastases on about 8 places in my bones. Instead of questioning why? Please commend me for fighting this bitch for 18 years. It’s cancer - your question is a bit inane.

[conagher in reply to MJCA]

Just seeking information and if information us insane to ask then I guess I'm insane. My treatments have been different and 3 Mets don't even show up on the last PET scan. Never had Lupron.

My apologies for asking.

[MJCA in reply to conagher]

Dude I said iNane not inSane - reread my reply. I have no right to refer to anyone as insane; that’s disrespectful. I went to your profile. Why don’t you tell us about you?? You have posted nothing nor even explain where you are in your journey? I’m a nice guy, I just found your comment strange. Would you rather have me dead instead of having this mf for 18 years? That’s how it sounds.

[conagher in reply to MJCA]

Should have said Bow Down. Would that have been better.

My journey is totally different. I have been reading this site since 2018. When I see post as yours I ask a question to learn. Not argue.

I've been fighting PCa for over 11 years along with 2 other cancers. I don't believe in most conventional treatments like your that last years. That's why I ask.

I've killed 3 that had Mets to spine, rib and lymph nodes. Never had Lupron or any testosterone stopping drug. At 78 with a normal testosterone level.

I've done Casodex for 2 years. Now I'm eligible for radiation which I've completed half and will finish up the end of this month and part of Sept.

I don't just except what my Oncologist says. I question her every visit. Same with my radiation oncologist.

When you've had them burn your head off your shoulders you just don't except BS from them.

[MJCA in reply to conagher]

Thanks for sharing. Every time I see my MO I always go with a list of questions. I’m glad Casodex is working for you. My body turned hormone resistant about 6 years ago. My journey has been a long one. There were periods where I actually forgot I had cancer. Unfortunately now we are looking at treatments that are there to extend life. I’m hoping to make it to 70, by then I will have had PC 25 years. My Dad almost made it to 98. As I tell people, it is what it is.

[conagher in reply to MJCA]

Since nothing is working for you have you question your MO as to why you cant have PSMA-617.

I wish you the best.

[MJCA in reply to conagher]

Actually Docetaxel is doing great!! Prior to starting chemo, my PSA was 23.6. After 6 rounds, my PSA is 7.3! I am VERY encouraged by these results!

Thank you for your kind wishes. I wish you all the best as well. I apologize if I misunderstood you earlier. I also apologize for my reaction and unkind words to you. Let’s put the past behind and move forward. We are all brothers in this fight together. I guess I was the A-hole brother today.

[Bubasurf6 in reply to MJCA]

did the use SBRT RADIATION on the 8 bone metastasis

[mrscruffy]

Not horrible but everyone's threshold is different

[Hidden in reply to mrscruffy]

Threshold of what?

[mrscruffy]

what people consider is expensive and reasonable. I find it very reasonable but not everyone is in my position

[Hidden]

Oh, yeah. The $1758 is the cheaper going rate for Lupron, so 20% of that is fine by me.

But where did they pull the $33,685.45 from???😱

[Jancapper]

You got a bargain, I was charged 56,000 for a single 6 mo shot. After deductions, insurance covered all.

[Hidden in reply to Jancapper]

You got the bargain!! Your insurance covered all!!

[bluepacifica]

To put it into some context, my husband got his first Lupron shot in February 2005. It cost a total of $1,800 at that time. There was only a 4 month dosage. (he'll be 20 years soon at stage IV. Embrace hope!)

Updated: We pay nothing since we have Medicare plus we have Plan F supplemental.

[Kevinski65 in reply to bluepacifica]

There’s a generic. Medicare pays for mine on ordinary Medicare with a supplement, I pay nothing. Medicare needs an approval form.

[Hidden in reply to bluepacifica]

Plan F pays the required plan B injectable copay.

Hang on to Plan F, its no longer available, only grandfathered.

[bluepacifica in reply to Hidden]

We will hold on to it for dear life! Went on Medicare in 2013 and have had Plan F ever since.

[KirklandKid]

I don't know where you live but here in Washington state we were able to apply for financial assistance through the Fred Hutch cancer center. They also jump through some of the hoops for us and apply to the manufacturer for a discount or no cost. Last year's income tax return is required. Lots of phone calls & paperwork but it's worth it!

[Flathead in reply to KirklandKid]

Yes! Yes! Yes! UW/Fred Hutch (old SCCA) does wonderful things. Seems the "list prices" are for Billy Gates and Jeffy Bezos. Your care team should have someone who can work with drug companies..most have programs for zero pay for lower incomes.

[Muffin2019]

You might apply for extra help through the hospital based on income, I did and it saved me money. The hospital financial office knows of grants you may qualify for.

[Cody2362]

I almost died from Lupron (blood pressure spikes leading to a whole series of incidents) ... check with your cardiologist before taking ADT drugs. I got switched to Orgovyx is Jan 22 and while still the same side effects , it's a bit more hospitable to the heart (or at least my heart). $10 copay per month for those qualified with private insurance ... those on Medicare aren't eligible but there is a program based on income that could be as low as $0.

[SilverSeppi]

Why are those on Medicare not eligible?

[Lewellen in reply to SilverSeppi]

I'm on Medicare, plus MA (medical assistance). I just got pre-approved for Orgovox.

[j-o-h-n]

Health Insurance is all fershimmeled.....

Good Luck, Good Health and Good Humor.

j-o-h-n Saturday 08/12/2023 1:39 PM DST

[rogerandme]

My copay is 183 for 3months lupron

[Ingress]

I knew folks in the States were getting ripped off on med costs but that is ridiculous. My 3 month Lupron shot cost €177.75 (~$195.00). With the exception code I have for PCa, I pay €1 (~$1.10) every 3 months. Gotta love big pharma and the insurance companies there.

[Hidden in reply to Ingress]

Yeah but which is worse big pharma or the NHS!!!😇

[Ingress in reply to Hidden]

Well…since you are paying out the you know where and I’m not, I’ll stick with big pharma here. Not to mention I’ve have had outstanding care here and haven’t paid a cent.

[Survivor1965]

It seems like Eligard is much cheaper. My 3 month was $1298

[Hidden in reply to Survivor1965]

My 6 month Lupron was $351.00

[dmt1121]

The cost is ridiculous. However, they control the market. Getting through your MO's infusion center means you pay full price. Doens't your insurnace have a cap on your out of pocket expenses?

The health care and insurance system is broken. Private insurers and pharmaceutical companies have no incentive to lower costs because they have the US Conress in their pockets...I belive we woud do well to explore some sort of national healthcare program for all that's decentralized and patient-focused. Maybe those who can, could pay more into the system but there has to be a way to decentivize raising prices beyond a reasonable profit margin.

Hope you find a way to get some relief...

[daysbetween]

As part of my initial treatment plan, I was being treated by a Radiation Oncologist and Urologist and was getting Lupron injections in the Urologists office and included in my co-pay of $40. Now that I am being treated by a Medical Oncologist and am being referred to Emory Hospital for injections the pricing looks like $3252, $780 discount, plan paid $2224 and my out of pocket is $247. This is the billing difference between receiving the injection in a dr's office and a hospital....insane. Im still trying to figure out how to get referred back to a urologist for the injections, but the emory team refuses.