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Medical Forum / Diseases and Disorders / Prostate Cancer / November 2005lupron and medicare payments
does anyone know if medicare pays for lupron injections? i have been told in the past that medicare does not pay for lupron but pays for a similar type drug instead. > does anyone know if medicare pays for lupron injections? Yes it does, unless "casey" is in a Medicare region that has elected otherwise. I doubt that there is such a region. > i have been told in the past that medicare does not pay for lupron but pays for a similar type drug instead. It will also pay for Zoladex and Trelstar, which are other LHRH agonists that perform the same function as Lupron. Interestingly, my med onc refuses to offer Lupron on the ground that Medicare does not reimburse even her cost of the drug. Whether other medics have the same difficulty I do not know. My rad onc, before I fired him, did use Lupron. Go figure. Regards, Steve J "Well, I've wrestled with reality for thirty-five years, Doctor, and I'm happy to state I finally won out over it." -- James Stewart as Elwood P. Dowd in "Harvey" : does anyone know if medicare pays for lupron injections? i have been told : in the past that medicare does not pay for lupron but pays for a similar : type drug instead. Medicare paid for two of my Lupron injections. The injections were only minimally effective and external beam radiation was recommended and performed. All that was over three years ago. Ken Bland > does anyone know if medicare pays for lupron injections? i have been told > in the past that medicare does not pay for lupron but pays for a similar > type drug instead. According to my URO, Medicare has lowered the payment for Lupron. It seems alot of Docs were getting free samples or buying the stuff in quantity at reduced prices and using it on Medicare patients to make more money. He says that if I need it again he will give the shot but will not break even on it considering his charge for administering the drug as well as its cost . The other drugs available seem to have a little more profit margin. Medicare also recently disapproved the use of Viadur (the one year shot that I finished up with last Feb) for the same reason they decreased the pay for Lupron. He says he will be reembursed about 80% of the drug cost and his fee to administer. > According to my URO, Medicare has lowered the payment for Lupron. It seems > alot of Docs were getting free samples or buying the stuff in quantity at > reduced prices and using it on Medicare patients to make more money. (snip) It may have something (or a lot) to do with TAP Pharmaceutical's marketing practices, which cost them something on the close order of one billion dollars when found out. See, e.g. http://abcnews.go.com/Business/wireStory?id=292630 Or google "Lupron & marketing practices" for more. Regards, Steve J >> According to my URO, Medicare has lowered the payment for Lupron. It >> seems alot of Docs were getting free samples or buying the stuff in [quoted text clipped - 14 lines] > > Steve J Yes, my URO also mentioned this as a cause. Quoting me quoting him: >>>According to my URO, Medicare has lowered the payment for Lupron. It >>>seems alot of Docs were getting free samples or buying the stuff in >>>quantity at reduced prices and using it on Medicare patients to make more >>>money. >> >>(snip) I responded: >>It may have something (or a lot) to do with TAP Pharmaceutical's marketing >>practices, which cost them something on the close order of one billion [quoted text clipped - 3 lines] >> >>Or google "Lupron & marketing practices" for more. And olfart replied: > Yes, my URO also mentioned this as a cause. Whaaaat? The uro admitted to a mere civilian what must have been common knowledge in the PCa industry?? My gast is flabbered! Do not let that man get away! Regards, Steve J "You must pay for conformity. All goes well as long as you run with conformists. But you, who are honest men in other particulars, know that there is alive somewhere a man whose honesty reaches to this point also, that he shall not kneel to false gods, and, on the day when you meet him, you sink into the class of counterfeits." -- Ralph Waldo Emerson > Quoting me quoting him: > [quoted text clipped - 27 lines] > > Steve J He is probably the best Dr (personality and otherwise) that I have ever had. 35 yrs in practice.. very down to earth, honest and practical.... but still up to date on the latest treatments. He was very helpful when I was having so much trouble with the SE's of IMRT ("it's not really my expertise, but try this for a few weeks"). Beat all my other Drs hands down on relieving the intestinal troubles. Not sure he has ever treated a flabbered gast before, but I'll check next time I see him (:>) I have been on quarterly Lupron shots for more than five years. In the beginning my doctor billed Medicare a little of $1700 and was paid about $1600. My most recent visit was October 11. He billed Medicare $673.23 and was paid $639.59. The bill for the office call was $54.40 and the payment was $47.30. Dick Winters >I have been on quarterly Lupron shots for more than five years. In the > beginning my doctor billed Medicare a little of $1700 and was paid [quoted text clipped - 3 lines] > > Dick Winters From these numbers one might guess that TAP (or somebody) was making a markup of over $1,000 on each injection. I'm guessing that at $639.59, TAP is still making good money. I haven't seen them exiting the Lupron business. It appears to me that the pharmaceutical industry has come up with a new and vastly more effective implementation of the old bandit's demand: "Your money or your life!" Alan It probably depends on what country you live in. > does anyone know if medicare pays for lupron injections? i > have been told > in the past that medicare does not pay for lupron but pays > for a similar > type drug instead. Right, Warren. I will tell the new group how it works in Ontario, Canada.....Warren can say if it is the same out West. Each Province has its own rules. But I don't think this fiasco could happen here, based on how Ron gets his Zoladex shot, etc. 1. We order it at the pharmacy. Costs about $1,250.00 (Zoladex) and because we are Seniors, we pay $6.11. So we are in charge of procuring it. 2. We take it to the doctor and he injects it and we visit for 15 minutes or so. No charge. Some doctors even use freezing, some don't. (G) Just so you know how our healthcare works, for prescriptions we pay the first $100 per annum in August and the rest of the year they cost anywhere from $2 - $6, depending on income. This low price also applies to people under 65 on low incomes, I believe. For those under 65 and working, most employers have private medical plans and cover half, if not all, of the premiums (Blue Cross, etc). So if you have a decent medical insurance plan, prescriptions are often 35 cents or so. Often a "benefit package" at a company is worth way more than a big raise, in my opinion. Our daughter got both at her first review, but was elated at how good her prescription/dental plan is. She works at a College in Vancouver. And I just wanted to basically point out that at no time does the doctor provide the hormone shot....he prescribes it, we order and pay for it. So no possibility for financial skullduggery there. Cheers.....Heather > It probably depends on what country you live in. > >> does anyone know if medicare pays for lupron injections? i have been told >> in the past that medicare does not pay for lupron but pays for a similar >> type drug instead. just to let you all know. i did some research with my oncologists office staff. i get lupron injections 3 times a year. at this time i am not on medicare but was considering going on same. the injections are 5k apiece for a 4 month lasting injection. medicare would allow what there rate would allow. after that the oncologists woluld write off what medicare did not allow and bill me 20%of what the medicare allowed. fortunately im on my wifes health insurance and only have a co- pay of $ 20.00 per visit. at this time i'm obviously going to stay with her insurance and reject medicare. |
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