This Is MS Multiple Sclerosis Knowledge & Support Community

Hello,

I am 22 years old and I was diagnosed with MS around 7-8 months ago. My doctor put me on Tysabri for 6 infusions after which I will switch to injection medicine. I am done with my 6th infusion now but what cough my eye after my last claim for the infusion was denied is the cost that my infusion center is billing my insurance. My infusion center is at Stanford University Hospital with my insurance company being Anthem Blue Cross.

Every month each clam is billed in the range of $22,000-$24,000. With the approved ones paid at ~$8,000. This can't be normal in my opinion. After I called Stanford Hospital customer support they told me that the bill states Natalizumab - 300mg at 76$/mg. Having searched around the web many people are stating that the cost is around $30,000 per YEAR--reasonable.

What are the costs to you guys? This sum of money seems outrageous to me at 22K per month.

Thanks!

I believe it was around 6,500 per treatment when my wife was on it, which was then discounted by the infusion clinic to around 3k for the insurance company. A little under 40k a year.

Well, up until yesterday, when I lost my job, I was scheduled for my first infusion. I was told by my insurance that they would cover 20% after deductible, and my share would be $500 to $700 a month (got approved for $10 copay for the tysabri itself by the Touch people though). So that's approx $2500 a month? Plus $70 for assorted stuff.

Now I don't have to worry about it because I will no longer have insurance after Memorial Day. Still owe a lot for the MRI I had to get during the recent relapse though. Yippee.

My infusion cost $3100 after insurance adjusts the amounts billed. I pay 10% of that 3100. The original marked-up charge for the drug is $4500 by the infusion center. Thats 13 infusions per year X 3100 = $40,000 per year.

ShootingStar - Bio Gen has a patient assistance program were you could get drug for $0 but the real challenge will be finding an infusion center that will give it for low or no charge. I would ask your neuro for some help finding an alternative.

Jim

Well I guess they charge more to the US government than to most insurance companies then? Cuz I'm on SS disability and it costs over $11,000 per month. But then I know our (bought) Congress several years back signed a law that (unlike insurance companies) Medicare couldn't make any deals with the pharmaceuticals for lowered prices for any drugs (buying "bulk" and all). Sigh. Yes, these amounts are indeed outrageous.

I've never taken the stuff, but I have in my notes that the costs are about $40K/yr in Canada and $91.7K/yr in the US with that getting reduced to $59.6K/yr negotiated through Aetna insurance (other insurance providers may vary in their negotiated price).

NHE

In SoCal with Blue Shield and in a University hospital it is $7200 dllrs per infusion. Blue Shield only accepts 6000 or so per infusion, so per year its $72000 dllrs. I pay $0.00 cause the insurance pays for everything after the deductible of 4K.
I have been told, however, that if you go to a clinic, or at a doctors office the cost is greatly reduced.

My insurance claim indicates the cost of the drug at $16,500, states that Blue Cross pays $13,170.
The total infusion including blood work and such is charged at over $17,000, with the insurer paying $13,800. The cost stunned me when I first read it. Thank God I have insurance that covers this right now ....

These outrageous prices drug companies charge is one of the reasons why so many of us are without insurance. Insurance companies have to pay so much money per month for all these drugs. Of course they are going to have to charge a lot for premiums. The consumers that allow this to happen are no better than the drug companies.

Just because one has health insurance doesn't make it ok to get these over-priced drugs. Especially when the effectiveness is in question. It's shameful so many people think this is good practice.

Wow - costs are all over the board! My local hospital infusion center bills my insurance for $8528 and my insurance pays $6268 with no cost passed on to me.

nancymno wrote:Wow - costs are all over the board! My local hospital infusion center bills my insurance for $8528 and my insurance pays $6268 with no cost passed on to me.

Just saw on another forum that Biogen and Elan raised the wholesale cost of Tysabri by 18.7% !! Whew!!

Harry

nancymno wrote:Wow - costs are all over the board! My local hospital infusion center bills my insurance for $8528 and my insurance pays $6268 with no cost passed on to me.

This sounds more reasonable. Where are you located by the way?

I will start calling up the facilities that can do infusions around my area to see if there is any difference. In my case Anthem Blue Cross has payed for everything so far (6 infusions) and I am extremely happy but with these outrageous costs I will be worried of reaching my limit.

WOW!!! That is all I can say. I guess it is because the infusion is done at a hospital? I get mine done at my neuro office and it is TONS cheaper....

My Dr neuro charges Aetna $350 of which Aetna pays $202 - my $25 copay. CVS Caremark fulfills my medication of which the charge is $3115.98 of which I pay $50 per infusion. I don't understand how hospitals can get away with the 500% markup they charge on stuff if not more. I mean hell last time I was in the hospital they charged $75 for tylenol!

I think I would call the manufacturer and discuss this with them. $22K per month is absolutely highway robbery!

I think there is one charge for the drug, and another charge for the infusion center, or wherever you go for your infusion, for the care involved. Luckily, I have Medicare and Medicaid, so I won't have an out of pocket copay.