LEUPROLIDE ACETATE INJECTION (45mg) 6 Month
Description/Modifier Billing Code J9217
Provider billed the plan $35,367.50
Total cost (amount the plan approved) $1,896.00
Your share $379.20
🤨 20%
HORMONAL CHEMOTHERAPY
ADMINISTRATION
$0
🤡
Lupron cost!!!: LEUPROLIDE ACETATE... - Advanced Prostate...
Lupron cost!!!
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Still_in_shock
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Wow, where are you being treated? Here are the details from my last Eligard (lupron acetate) 3 month injection.
Cancer Center billed $2164.00
Medicare approved $563.87
Medicare paid $449.26
I paid $114.61
Thank you....covers the question Google had been only partially successful in doing!! Hope that also applies in Oregon!!! I had been guessing $1500, and I would pay $300....so this is great news!!!
I was covered for my 28 days of radiation at Kaiser, but I was just reviewing Kaiser's billings for those 28 days of RT only...not the ADT, RO consults, etc. Total $80-$90k !!!! Then I read that in 2019 Medicare paid $12 k for the same 28 days !!! But, Kaiser , at the $80-90K, was below the mean of smething like $110k in 2019. That is based on "posted prices', so who knows what the clinic averages overall for Medicare, commercial, and cash payer patients? It looks like too me that Kaiser billed approx $1500 for the 3 month shot......takes a nurse 5 minutes, Eligard must be very expensive for a 3 month dose?
Thanks again for your info!! Yippee!!
I guess theoretically clinics/hospitals would all go bust iif they only had Medicare patients?
Supposedly, Kaiser is non-profit????? $90k????
Kaiser Foundation (insurance) is a non-profit.
Kaiser Foundation is exclusively contracted with the Permanente Group of doctors (FOR profit) and the Kaiser Permanente Hospitals, labs, pharmacy, clinics, etc.
With an integrated healthcare system they are a FOR PROFIT system hiding behind their non-profit insurance arm which is what they lead with in so much of their advertising "KP is not for profit". Just another one of their deceptive practices.
OK. So, other than the Docs, who is pocketing the profits? There are no private owners or shareholders that I know of? I understoood that there is the group of Docs, and the other arm consists of insurance and the facilities? I don't have the actual numbers, but I don't believe that Kaiser Docs earn more than the average for Docs?
Profits are needed to main tain the facilities, equipment, new equipment, etc.....so yes, there are profits that must be earned for that purpose.
here's a snapshot from a reddit post from a KP doc:
More than three decades in California, and I have worked for all three of those organizations at some point. Kaiser doctor salaries are actually paid by a Permanente Medical Group, a huge medical group exclusively affiliated with the Kaiser organization in each state.
Kaiser-Permanente means the combination of Kaiser, a huge non-profit insurance company that owns hospitals and clinics, and a Permanente Medical Group(PMG) that has an exclusive contract to provide physician services to Kaiser in that state. Only MD’s and DO’s belong to PMG. Kaiser negotiates the contract with PMG, which sets the salaries and benefits. Salaries in CA are nothing to sneeze at, but a motivated doctor could make more money elsewhere with hard work, perhaps much more money for an astute physician businessman with a tireless work ethic.
But PMG has a legitimate pension plan with a generous multiplier. The Deferred Compensation plan has a handsome match. Health Insurance and life insurance are, or were free in my day. PMG has a profit sharing distribution and a mortgage program. The value of a lengthy Kaiser career, in CA anyway, is potentially so high that the partnership buy-in could readily exceed the down payment for a well-situated CA home, so high that people borrow money from PMG to pay for the PMG partnership, and take years to pay it back. On leaving the group, it’s sold back to PMG, with appreciated value.
This package rewards a long term commitment to the organization. In return, PMG demands a lot from its doctors. The patient loads are high, and the standards. Many doctors leave without gaining partnership. To make it a career, a doctor has to be very efficient in time management and have good clinical skills. We called it the Golden Handcuffs.
I have a lot of good things to say about my years with PMG, some bad, from a personal and professional perspective.
He confirms my understanding of the system. Yes, MDs, including those at Kaiser, havea profitable career in general. Some are worth the $$$, and more, and some should be in a different line of business!!
Interesting.
So am I correct in undersealing that MDs with PMG are literally employees, i.e., they receive a W2 at the end of the year? I ask because it is also my understanding that most if not all MDs working for most other hospitals and health care providers are independent contractors, i.e. they receive a (or many) 1099 forms at the end of the year. This came up in California because MDs are one of the few exceptions to employee vs independent contractor rules.
My husband doesn’t pay anything for his Eligard injections every 3 months. Medicare pays 80% and his supplement AARP United Healthcare picks up the remaining 20%.
He pays indirectly...those monthly supplement premiums. Insurers receive more in premiums than they pay out in benefits, of course.
Same here
Same here. The amount Medicare pays is about 10% of the stated gross price.
Wow. My Medicare paid in full. It is not a drug bill. It's a fully covered office visit.
It’s a part b 20% copay which your supplement covered.
Medicare Part B pays 80% for such services...do you have a supplement?
Ahh...yes, that's the answer. An important thing to have for me.
Curious, I'm still many years off from 65, but what do you pay monthly for your supplemental insurance? I'm setting a separate retirement account specifically to cover these costs.
Medicare.gov and look for the medigap policy selection at top menu.......you'll find exact prices for your zip, age, etc.
As maley2721 says, it will depend on what plan you choose and where you live. I started 5 years ago and I now pay about $140 per month for Plan G supplement through AARP/United Health.
If you purchase 200 shares of ABBV, the dividend will cover more than your $379 bi-yearly co-pay.
Last one until Medicare!!!👍
True, but all of you missed the elephant in the room.
"Provider billed the plan $35,367.50"
Nah..we saw that elephant. Meaningless number. Could have been 100k. Your insurance already agreed to the lower amount.
No elephant IMO. Just silliness that has no effect on what any party pays or receives. Per prior topic, we should demand more transparency in drug and health care prices.
💯%!
It's absolutely ridiculous what's charged in healthcare.
My mom works for a neurosurgical group. A patient came in and needed a similar procedure as another patient - two level fusion cages. She looked up what had been billed to the other patient - $498,000 for the hardware alone.
To your point, where the hell do they even come up with these prices to charge.
A year or so ago, I saw a website that showed a wholesale price of Lupron Depot (6 mo) of about $9XX to $1,200.
Another guy in my local area on Medicare said that his provider charges the insurance $12,000 for a 6 month injection. That's 10X the wholesale price. Absolutely crazy!
I'd bet $1000 that Medicare will not pay that Doc $12k for that 6 mo Eligard !!! See another reply above .....Medicaare paid approx $500 for a 3 mo shot!!! Medicare doesn't give a damn about what any one Doc charges for something!!!! Why there are Docs who don't accept Medicare!!!!!!!
I've never paid anythingn for my Lupron injection. Not sure it matters but I am on Medicare and have a Supplement plan.
Not Medicare.
Good morning, this is an interesting conversation to me, after my experience this past few weeks. I get Lupron every three months. I am self pay, and use a faith based discount program. Last year and up to Dec 2023*, my Lupron was $2566.00 plus, lab's and office visit etc. Total out of pocket was $1337.42 for everything after discounts. I got injections in March and June but did not get the bill until right before my Sept. Injection. Lupron was 33,114.00 plus lab's and office visit. Total out of pocket is 10,383.00 after discounts. I thought there must be a big mistake in the billing department. They are looking into it for me, I have not heard the final verdict yet. I told them I would have an Orchiectomy surgery before I keep paying that much. We will see what happens. I turn 65 this coming Dec and l am starting to look at Medicare and what supplement I want etc. Sometimes self pay looks easier except that the costs do not and will not become any easier. Have a great day! Trying to live life to the fullest and being grateful for everything that God has given to me!Thanks
Again just my experience
Keith.--aka JDguy
The same provider/clinic changed your billing by that much? Justification they gave you?
Yes the same clinic, they have not given me the verdict yet. I have not paid them yet. They have not given me answer why yet. The person I talked to said they changed phama companies and something does not look right. They have found some other discrepancies also. So we wait and see. Thanks
Make sure you get REAL Medicare, do not get advantage plans
Been on Lucrin(Luprin) shots every 3 months for the last 18 months here in South Africa. The US$ equivalent for each shot is $385.
I don't know how it works there and your situation, but have you considered estradiol patches (if you are not metastatic)?
Estradiol patches don't work if you're metastatic? I haven't heard that before.
Nah I think they do but the results of patch trial that they have released are for non metastatic PCa, because the primary endpoint was time to first metastasis (which gave a slight, statistically not significant advantage to estradiol). For metastatic disease they are measuring OS. Probably with some statistical interpolation we will know more about it soon.
I get a monthly Lupron shot. Dr. bills my Medicare Advantage plan $650, plan pays $180.54 and I pay $36.11.
I get the 3 month version for:
Billed insurance $2,668.00
Discounts And Reductions $2,402.04
Paid By Your Plan $265.96
I used to get the 6 month version and it was billed out ~$6K
My Apalutamide (120 pills/month) gets billed and paid for ~$15-16K
Not directly related, but in my comic I added up the (charged, but not billed) costs just to get diagnosed. It was $69k. That year I paid about $6k out-of-pocket.
Since then, I have paid practically nothing, including my treatment (28 sessions of EBRT). I keep expecting some horrendous bill to appear, but nothing so far. Fingers crossed.
That was all before I turned 65. Now I have Medicare + supplemental. I’m very lucky that my doublet therapy (so far) is paid by grants and manufacturers programs. Orgovyx + Abiraterone would have added up pretty quickly.
Cost of care
Unfortunately or fortunately, you shouldn't focus on the "Provider Billed" number. The whole medical billing system is a hot nightmare. My most recent monthly prescription for Abiraterone (typical cost to me is not more than low three figures) showed a price of more than $7,000.
Excellent story here about how the system is gamed and the role of "pharmacy benefits managers" (and you now know why Express Scripts has been running full-page newspaper ads about the good work they do...)
There is a huge underlying reason with regards to why they charge such upfront numbers.
Lot of hospitals are for non profit and they need to provide some level of charity care to maintain that status.
When their charge is $10k, even if negotiated rate is $1000, let us say when they provide charity care, it is like they are provide free service of $10000 rather than 1000. Essentially a system where they adhere to law, but not to the spirit of law.
"Provider billed the plan $35,367.50"
I always thought it was an accounting practice on the year end tax reporting.
Net loss at the end of year towards profit so in actuality Hospitals and providers, meaning there’s no taxes to be paid because of the offset. Another way of saying a non profit.
For those on permanent ADT, long term, usually recurring PCa treatment, the regular administration of these shots would add up to a fortune.
When my G9 5+4 case was recurring a few years ago, the only realistic option for me was permanent ADT. Knowing that, I chose to have an orchiectomy, getting rid of the source of my testosterone permanently. One and done, and the surgery didn't cost much more than on six-month Lupron shot. I don't ever have to have another of those shots, and incur none of the other side effects of Lupron or its kin. Of course, I do have to cope with no T, but I'm on estradiol and feel better than ever.
Doctors, their clinics, and the pharmaceutical companies make a fortune on a lifelong revenue stream from pills like Orgovyx, or routine shots at several thousand each. No one offers orchiectomy. But for me, it was a more palatable option than being on the Big Pharma carousel for the rest of my life.
I was on Lupron for years before the orchiectomy and now I feel so much better! Wish I had done it at the beginning, as my urologist at the time offered it right at the start.
Very good! I asked my MO why orchiectomy is rarely, like *never*, offered in the US. He said they used to suggest it often, but most have given up due to the very low take rate for it. Most guys will happily take the medication forever. In the support groups I attend, my choice(s) turn out to be exceptionally rare. It's ok , this is my choice and I'm very pleased with it.
It's all an accounting process..... I be counting on my fingers and I be counting on my toes..
Good Luck, Good Health and Good Humor.
j-o-h-n
Your share $379 for a medication, if you travel to Mumbai, India, costs less than $200. Now, how is it that a medication that sells, routinely in India, could ever be billed for $35,000. Welcome to America and the Pharma King's grip on healthcare.
Just search IndiaMart.com (unless, as sometimes in the case of an error or "forbidden," you are not allowed to see that website.
Now some will cry.... OMG, made in India.... scam. Nah, either your T drops to the right amount, or not. India has been making most of our meds now for a very long time. I've used India made meds for over a decade, naturally, if you travel there, do your research. Cipla, Dr. Reddy's meds all made in India.
My PSMA pet scan billed at $29,000, with the same exact "tracer," in Mumbai is about US$400.
Welcome to America's predatory pharma industry.
PSMA scan should be around 6k. 1k for the scan and 5k for the tracer. Since the tracer degrades pretty quick, they need to manufacturer the tracer and deliver by courier to the imaging center in a proscribed manner. Regardless, I doubt I'm getting a round trip flight to Mumbai a 3 day stay, food,etc for under 6k.
Very sad. Lupron is a very old drug. The pricing is legal gouging. Greed is only answer. Seems insane list pricing is a huge part of medical pricing. Big Pharma, hospitals, doctors all do it.
The medical system is corrupt in the United States. ☹️
If you were visiting Australia your full price is about US$500 for 3 month depot.
The out of pocket cost to all Australian residents is about US$20.
The thing is in the US a hospital can charge whatever they want to charge. I've received Lupron shots at four different hospitals and the prices are all different, some close, some real outliers.
It's the same for PSMA scans, one hospital charges $36,000 plus office visits so $38,000 for a scan. The insurance BCBS reimburses them I think it was around $2000 more than another hospital that charges $22,000. Then there is another that charges $16,000 I think and got paid $12,000.
Now the most prestigious hospitals were on the lower end.
I've tried very hard to get the price ahead of time and you might as well be spinning in the wind, they will never tell you.
And right it doesn't effect you if you have in network insurance but if you don't have insurance you're on the hook for the full bogus amount.
As stated by someone else this is all part of a game to show how much free healthcare they give away, but in reality the cost are actually very small but jacked up until unrecognizable. It's all fake and the funny thing, if you call it funny. Most not for profit hospitals don't come anywhere near their obligations on free and discounted care.
Then some require you pay a portion up front and then the rest later. Now it's also funny on how doing that reduces each portion of the bill from being in the valid range for assistance on your bill from the hospital. Where it would be if they charged you all at once, just another trick.
God bless the US.
In Alberta Canada the cost of Eligard injections is fully covered by our senior medicare program. Thank heavens!
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