help with neulasta shot

timerdog

I'm not even sure if that how it is spelled but it is a shot that starts day 3 after chem and is given for 7 days in a row. apparently you can teach yourself how to do the shot or a home care person comes in. I am in the hospital right now due to fever and low WBC, my last chemo is on the 17th and my onc tells my that I now need to have this shot to boost my WBC. I got the impression this shot is not covered by OHIP.

Can anyone tell me their experience with this shot and if was covered by the health care system.

Thanks

sanbar8771

Sometimes Neulasta is not covered by insurance but I think this shot is given only once after chemo. I was on Neupogen (SP?), and that is a shot they give you everyday after chemo for 7 days. This shot does the same thing as Neulasta but you have go 7 days. Neulasta is only given once. I was not able to come up to the cancer center after one treatment so my health insurance allowed me to get one Neulasta. They would not pay for it again. I guess Neulasta costs $6000.00 here in the states. I would ask about Neupogen shots. I am pretty sure insurances will cover. Hope this helps.

crazy4carrots

timer -- I'm fairly sure you are referring to neupogen.  It starts 3 days after tx and yes, you can learn to administer it yourself, or else a visiting nurse can come to your home and give it to you (my DH learned to give me the shots, subcutaneously -- in the tummy.  Do it slowly, use a very sharp, skinny needle and it doesn't hurt at all).

If you have supplemental insurance, that will pay for it.  However, although it is not covered by OHIP, there is a special "fund" that your doc or pharmacist will know about, and you may be able to avail yourself of it.  Otherwise, the cost is $200 per shot.

mks16

lindasa, I thought Neupogen was covered by OHIP?

In any case, timerdog, like Lindasa said, there are payment options out there, and the pharmacist at the hospital will know more. My insurance covered 80% of Neulasta and the hospital pharmacy and my local pharmacy worked together to obtain coverage for the remaining 20%, so I don't have to worry or make any  more phone calls than absolutely necessary. Hopefully your team will be as helpful and please let them take care of it. You shouldn't have to worry about that on top of everything else!

Hope you feel better and go home soon!!

crazy4carrots

OHIP pays for drugs administered in Hospital.  I believe Neulasta is usually administered in Hospital the day after tx, but neupogen shots are administered at home.  That's the difference (unfortunate as it is, and let's hope it gets changed soon!)

Luah

timerdog: I had a single neulasta shot one day after each AC treatment. The nurse at the cancer centre did it the first time and showed me how to do it the next 3 times. Pretty simple, actually. The cost back in late 2009 was $2500 a shot, but the cancer centre pharmacist and my husband's insurance administrator and the manufacturer worked together to cover the entire cost.  (Neupogen is similar but given for several days, as the ladies here have said.)

I thought I had heard that OHIP was now covering this in some situations? In any case, yes, your onc or pharamcist should know about programs under which you'd qualify.   

timerdog

Ok, I just started bawling my eyes out! I was wondering why the onc was asking me about private insurance. this cancer ordeal has left me almost penniless. I am the sole provider for my daughter and due to the fact I work around children my onc said I can't work. Yeah, just another thing on my plate.

I just got release from hospital due to fever and had one of the worse days of my life.

Time to do some creative math.

Thanks all! 

Luah

timerdog: The drug maker has a program (Victory) that you very well might qualify for, so please don't despair!  I hope your pharmacist can help make some arrangements.  

Kathy044

timerdog, neuprogen isn't covered under the gov't Fair Pharmacare program in BC either. I have extended insurance but have an annual cap for the amount paid for prescription drugs and needless to say quickly met it. I too was devastated. I'd heard about the Victory Program here on BCO though thank goodness.

Here's the phone number, they will tell you what you and your onc need to do, the Victory Program works through your pharmacy and you pay the pharmacy a small amount to cover the handling and dispensing costs. I am not low income, but not rich either and qualified.

http://www.amgen.ca/english/patients/patient_assistance.html

crazy4carrots

timer -- Just to add some more info:  when I was prescribed neupogen, the person who was organizing the visiting nurse service told me that if I didn't have supplemental insurance, she would give me a "special card" to take to the pharmacist.  I didn't need the "special card" but I understood it to mean that the neupogen would be paid for (and not by me!).

Do get all the info you can about this, and make it clear that you cannot afford the high cost of this drug.  I'm confident you will be able to get it.

Sending many hugs,

Linda

timerdog

Thanks all,

I'm looking into ways to handle this mess.

Lindasa which province are you in? I have heard in AB that it is covered.

I'm checking into the links and will call my Onc later today with my findings.

crazy4carrots

Timer -- Same province as you!  Wishing you good luck.

timerdog

How was the shot Linda? Did you have SE's from it? How many is a row did you have them? Why did you have to have them? I had fever and was in the hospital. My last chemo is on Tuesday, thank God for that.

So, I had to fill out a Trillum drug plan forum, and the Sudbury will do the rest. Not sure what the cost will be t the end. Cancer is not cheap! 

crazy4carrots

Timer -- I started out with 10 shots (neupogen is sold in 10-vial packages) but my white cell count was still a bit too low so it was upped to 12 shots between tx.  I never had any infections during chemo, fortunately.

So glad to hear your tx are almost finished!!  And I have a feeling you probably won't have to pay anything for the shots.  You're right -- cancer is not cheap -- but from what I've read on other threads, it's a lot cheaper here than it is south of the border.

Wishing you the best,

Linda

bdavis

My Neulasta shot costs $4000 I think and I get it 2 days after TX, since you have to have it between 24-72 hours, I go first thing 2 days later... and I go to my doctor's office and they give it to me... Last Neulasta tomorrow... and I pay a $25 co-pay and its covered by insurance.

crazy4carrots

Betsy -- Sounds like you just had your last chemo -- hurray!  Hope you're able to celebrate getting through it all very soon!

bdavis

Yes... silently celebrating... Off to New Orleans on Saturday for a doctor consult... I hope I will feel ok... since Friday is my down day.

Amara

Hello,

I'm an ontario resident, but currently in the UK. My last chemo is on may 20th and I plan to move to Canada after that. I have not had my mastectomy, reconstruction and radiation yet. I am also on Herceptin. Can anyone please let me know if all that is covered by OHIP? Thanks.

crazy4carrots

Amara -- how long have you been out of Canada?  If everything is in order, then all that you have mentioned by way of tx will be covered by OHIP.  Drugs that are required outside of Hospital are not covered, however.

Kathy044

An old thread from 2011 I know but with the loss of the Canadian Connections thread it is the best way I know to resurrect a place for new members to ask questions about neupogen and /or Neulasta shot payment across all provinces in Canada in 2015.

So I am bumping this for Thaya123 from Ontario who recently posted a question about Payor for Neulastra Shot on the Employment, Insurance, and Financial forum.

https://community.breastcancer.org/forum/113/topic/829886?page=1#idx_2

Kathy

DayLily15

thank you Kathy044- interesting - i was told the neupogen here in alberta would be about ~$1500

do you know of any other huge drug expenses we are all likely to encounter in Canada ?

JJ62

In Saskatchewan Neupogen is listed in the provincial fomulary, and therefore covered by the province. Oddly my health care providers were not certain of this when dispensing it! ? That was in 2010.

Lolis197138

Check out Victory program, the manufacturer pays part of the cost that is out of pocket (if you don't have 100% insurance coverage). I had to give the shots myself after the first time :-)  

CatsRus

I posted this on the linked post above (link provided by Kathy044. Though I should probably post it here too. Hope my experience is helpful.


I am currently getting the Neulasta shot covered by my private coverage ($2700 per shot - 1 after each round of chemo). I was told that if I hadn't had coverage, Neupogen would have been prescribed as that is covered. Suggest you ask your MO about switching to Neupogen. It involves more shots but the CCAC home nurse will teach you how to do it. I believe it's like the Neulasta shot, also similar to the type of shot diabetics use to give themselves insulin, very easy to do yourself. The home nurse had me do my own Neulasta, with her instruction. I was very reluctant - I kept thinking it $2700, what if I do it wrong! It was incredibly easy and I'll happily do my own from now on rather than having to wait for the nurse to come. I had my first Neulasta at the hospital by the chemo nurse as they wanted to check for any reactions. Although it was administered at the hospital, I still had to pay for it and go through my insurance for the refund (I usually have to pay and submit for all my drugs). One other thing, while under CCAC for follow up care (ie after both my surgeries and during chemo re the Neulasta shot), all covered drugs are being paid for under the Ontario Drug Benefit plan. I should pay $2.00 per item, however apparently all pharmacies waive the fee.


Good luck. Hope this has given you some things to ask about.


Oh, one more thing, although you may know.....the Canadian Cancer Society will also cover the cost of a free wig for Canadians without any private coverage for one. I've been to two Wig boutiques and they were both fully aware of the program and had the paperwork right there.

sbeddows

Hi all. I am a bit confused So I have a 10k annual cap with insurance and am about to start chemo.....I will be having neulasta to begin with then I think they will switch me to neupogen after 3 shots.....will I have to pay for the neupogen (as my insurance will have maxed out) also how about anti emetics?! I am in Ontario Canada.....Thanks all!!

sio

Hi sbeddows, I'm also in Ontario. My understanding is that OHIP pays for the Neupogen. At the cancer center I go to, the Neulasta is $2700 per shot. So, you might want to keep an eye on your insurance cap as if you are going to need anti-nausea drug prescriptions. It looks like mine are going to run at about $400 per treatment. My clinic enrolled me in the Victory program for the Neulasta shot. My insurance covers 90% of the cost, and the program covers my 10% copay. The cancer center pharmacy arranged everything. Perhaps talk to the pharmacist at your clinic?

CatsRus

I agree with Sio, talk with the pharmacy at your cancer clinic. I had to pay up front for Neulasta ($2709.85) but was reimbursed by my private medical insurance. I was told if I hadn't had coverage for it then Neupogen would have been prescribed as it is 'covered'. To be honest now I don't know if it is covered by OHIP or the Ontario Drug Plan. I was put on the Ontario Drug Plan by CCAC each time I was referred to them - after each of my two surgeries and to administer the shots - and while on the ODB all my prescribed drugs (except Neulasta) were covered. Your pharmacist will be able to advise you re your coverage. It may be better for you to just do the Neupogen rather than using up your coverage to pay for the Neulasta.

Good luck