EOB shock - Taxotere cost $$$$

I can't answer to Taxotere specifically, because I got its' sister drug, Taxol, instead. However, I am self-pay which typically is billed at a higher rate than the negotiated price between doctors and insurance companies. My oncologist did give me a discount, though. Even so, I am sure I did not pay any less than what they would have gotten from an insurance company, Medicare, or Medicaid.

For 120 mg of Taxol each week, I was charged $80. The billing rate was $20 per 30-mg dose, thus 30 x 4 = 120 total. 

Does your EOB break down how much the onc is charging per mg for the Taxotere? 

 Just FYI, while I was on that protocol with the Taxol, I paid $700 for each weekly infusion. This included Taxol, Decadron, Aloxi (which was by far the most expensive item but well worth it!), saline, CBC, and chairtime. I was on that protocol for 12 consecutive weeks, and so paid less for that entire time ($8400) than your insurance paid for only your last two chemos.

Was the $20K/$11K for the Taxotere only, or for the entire treatment package per visit? I was told that a typical chairtime reimbursement by an insurance company is $300/hour (computed with any fraction of an hour being charged as a full hour, just like cellphone companies do with partial minutes of airtime); so if you are there for 3 hours per treatment, that is $900 just for the chairtime and nothing else.

As you have noted. it IS possible for a bill to be miscoded,  either by the hospital or by the insurance company.  Keep pressing them for details -- it took me almost a year to get $70 of charges off my record when somebody at the insurance company coded two infusion clinic visits as "emergency room" visits (they got confused by the word clinic ?) with a higher copay for me, even though the same  treatments at the same  clinic were coded correctly both before and after the dates in question. 

Not to mention thousands of dollars of  radiation treatments (at another hospital) billed for days before I had started treatment.

It's the Herceptin that makes up the bulk of the cost of TCH; it's obscenely expensive, thousands of dollars per bag even at the negotiated rate with insurance companies.

I tend to agree with lauri (that the charge is a miscoded item that shouldn't have appeared on your bill in the first place). It could have been sent to the ins company for an account # or patient ID # that's just one number different from yours, but whoever typed it or wrote it up made a mistake and it ended up going in as your number instead.

Especially since it showed up as "pathology". Pathology bills are often big-ticket items, but what puzzles me is how a pathology bill could originate in an oncology (rather than a surgery or surgery-related) practice or department. Usually what oncs send to the lab are blood samples (hematology) rather than tissue samples (pathology). 

 I think someone somewhere slipped up on the ol' keyboard that day...

Hi Shelley,

I almost had a heart attack when I received my first EOB... the total amount billed was $19,919!  The breakdown: T: 1mg, 5,880 billed (ins pd 2,432.40 & my co-ins was 486.48) C: 50 mg, 3,900 (72.28 & 14.46) and H: 10 mg, 7,680 (3,576 & 715.20)  The insurance company also paid about $460 for chemo administration and I had reached my out of pocket maximum for the year at that point - thankfully! 

Hope this helps, I'm sick of insurance companies taking advantage of us- go get 'em!!!  By the way, don't hesitate to argue with them if you notice something wrong.  I spent over two hours on the phone doing just that the other day, but I was right and saved myself a bunch of money because if it.  Unfortunately we have to be our own advocates not just with our health, but with our insurance too.  As if we didn't have enough to worry about!!  

WOW I am surprised at all the costs listed above! I had 4 rounds of Taxotere and Cytoxan, my bill for one treatment was $5500 ins contractual adjustment $3500 and I paid $2000. I have a high deductible so that's why I had to pay, but I was loving the contractual adj of $3500. I am not sure the dosage but that bill also includes all my pre-chemo meds including Emend which is a couple hundred. I bet there was a coding error.

Diane

LadyMadonna, just curious, was your first EOB amount for the Herceptin ($7680 full; $3576 adjusted) for a weekly dose, a bi-weekly, or every 3 weeks? I was on Taxol + Herceptin weekly while on the combo regimen. Genentech, bless their hearts, agreed to supply all my Herceptin for free and so it didn't appear on my invoice from my onc at all; but I am curious as to the actual cost of that nowadays to insurance companies for a comparable dose.

If you were getting it weekly, then the full (self pay) price would be $7680 x 52 = $399,360 (now there's a mind-boggling number) but I have heard/read elsewhere that a typical "full ticket price" for a year of Herceptin is more in the area of $180,000  to $200,000. Which is still mind-boggling of course.

Also did you mean to type 100 mg of Herceptin (not 10)? Because my weekly dose is 98 mg and I weigh only about 108 lbs; I know the dosage is weight-dependent. So a 10-mg dose of Herceptin would be for a body weighing only about 10 lbs or so. And actually the first (loading) dose of Herceptin is commonly larger than the subsequent ones (that's why they give Benadryl before that one) but usually not before the infusions after that.

That Taxotere billed cost for you and kmmd is staggering! I can't fathom why they are charging so more more for that than for Taxol which is similar enough that patients who for some reason can't tolerate Taxotere are switched to Taxol instead. There is a 2004 study about the functional differences between Taxol and Taxotere (it's at http://theoncologist.alphamedpress.org/cgi/content/full/9/suppl_2/3 if any other "research geeks" like myself are interested    )  which goes some way to explaining it, but the difference between my $20/mg cost of Taxol versus your  $2400/mg negotiated cost of Taxotere on those EOBs is even beyond mind-boggling. There is not IMHO a $2300-per-milligram difference between those two sister drugs! Yes, Taxol is 30 years "older" than Taxotere, and we all know that 'new models' of anything are always more expensive    , but still ... a huge differential like that for such similar drugs is just plain nuts.

I think the choice of Taxotere vs Taxol pretty much comes down to two things: (1) cancer stage and node involvement, and (2) individual oncologist's preference/opinion. Taxol/Herceptin is being used more and more for Stage I node-negative (in fact in many places I think it is becoming the standard), and increasingly for Stage 2a if there is no node involvement. There are several completed and ongoing clinical trials which have shown/are showing the same level of response in early stage/non mets cases to TH as to TCH, with the added benefit of less overall toxicity to the body. 

The individual-oncologist factor is huge though. There's such a difference in opinion regarding certain drugs and combos for the same set of patient circumstances. There are probably as many oncologists who would now never use an Adriamycin/Herceptin regimen, as those who are still prescribing it -- to cite just one example. Pretty scary stuff.

Some oncologists won't budge an inch from the published "standard of care" in a given situation, while others (like mine; otherwise I would have found a different onc!) are more flexible and open to alternatives even though those may not have quite as long a list of statistical outcomes behind them. Time does pass, after all, and what isn't yet the most widely accepted standard of care today may well be in that elite company 5 years from now after more and more clinical trials and numbers make their way into the stats. 

Carboplatin "went generic" in 2004, which accounts for the price drop. Taxol was originally proprietary to Bristol-Myers Squibb, but is now generic, and BMS doesn't even make it anymore. Technically it should just be called paclitaxel but most people still call it Taxol. Teva Pharmaceuticals is a major producer of generic Taxol for the US market, although there are at least 4 other companies who also make it (Ivex, one of those companies, calls it Onxol though).

I just discovered via some Googling that Taxotere is NOT yet generic though...  which probably accounts for its still-hefty price tag! Sanofi-Aventis' patent on Taxotere is due to expire this November but S-A holds "exclusivity rights" which will prevent any other company from marketing a generic version until at least March of next year (2011).

IMHO that's the major reason for the ridiculous price versus Taxol, and I'm sure that once a generic version hits the market the cost of Taxotere will plummet!

I haven't gotten an EOB yet, but the cancer center gave me a quote for a typical TC treatment before my first chemo of 6 was scheduled. The total is $13,500.

The biggest items (approximately) are Taxotere $3000, Cytoxan $400, Chemo iv admin $750, Aloxi $800 and... Neulasta $8000. No Herceptin.

The high cost of Neulasta for a self-pay patient like myself was one of my big selling points when I put my case to my onc for wanting Taxol versus Taxotere (there were several side-effect-related reasons too, but the cost of Neulasta was just as important a factor).  Patients on Taxol usually don't need Neulasta, because their WBC doesn't drop as much as it does in people who are on Taxotere. When I found out that the typical cost of a Neulasta shot can range from $3000 to $8000 I nearly had a coronary on the spot!

Many oncs join a co-op from which they agree to buy all their chemo drugs, and they sign a contract that says they cannot buy their stuff from anyone else. Because of the co-op's buying power, the overall average cost to the onc is usually less than if they bought the same drugs from an individual supplier, but each co-op will vary in what they pay (and thus what they charge their member oncologists) for a specific drug. So  maybe Co-Op "A" gets a great price on Taxotere from Sanofi-Aventis, but they can't get as good a deal on Neulasta from its manufacturer, Amgen (you guessed it: there is no generic Neulasta and there never will be for reasons I'll explain in a minute).  But Co-Op "B" gets a better deal on Neulasta but not such a great one on Taxotere. The oncs who belong to Co-Op A will charge more for Neulasta (because they'll be paying more for it from their co-op), and the oncs belonging to Co-Op B will charge more for Taxotere.

Okay, here's the story about Neulasta never having a generic. Neulasta is classified as a "biologic" or "biotech" drug, meaning that live cells or bacteria are used to actually produce it. Neulasta is a synthetic protein that is produced by the action of a certain (live) bacteria. Drugs like Taxol and Taxotere have no "living" component to them. The process of approval for a generic drug is different for 'standard' and 'biologic' drugs, in that for a company to produce a generic version of a standard drug they don't have to repeat all of the human studies that were done when the drug itself was first approved for sale on the market. All they have to do is prove to the FDA that their generic is exactly the same as the original (which is fairly easy).

But in order to get a generic "biologic" drug like Neulasta approved, the generic-making company is required to do all of the human studies all over again for their product. The generic company would have to start all over again from Square One in order to get their generic approved. Doing those studies is hugely expensive and time consuming, as everyone knows. It would essentially be the same as if the generic company were developing a brand new, entirely different drug for that condition. Of course they won't do that; that's not their business model. Even if they did, they would have to charge just as much for their "generic" version as the original non-generic cost, in order to recoup their developmental costs. So Neulasta will never be noticeably cheaper than it now is.

Neupogen, the other whitecell-producing drug (also made by Amgen), is also a biologic and so will not have a generic version either. They are essentially the same drug but the length of their effects are different. Neupogen shots are a lower dose and thus have to be taken in sequence over several days; a shot of Neulasta lasts longer (hence the name  ) and thus only requires one shot instead of several to get the desired result, but its side effects are more intense and the cost of  it is higher.

Interestingly, some countries in Europe are not as strict about generic versions of biotech drugs as the US is, and there has been some talk about a generic version of Neulasta being produced over there; but it wouldn't be allowed in the USA even if there were one. 

(edited to add:  Btw, yes, Herceptin is a "biologic". So although Genentech's patent on it is set to expire in 2015, don't hold your breath for a less expensive generic version to appear in the USA anytime soon   unless Congress were to someday rewrite the FDA rules for the approval of biotech generics and make that process the same as for chemical-based drugs.)

Wow - lots of good info in here. I'm probably going to have to switch to Neulasta from the drugstore or Neupogen - all this has to happen after the first set of EOB's because my insurance company will not provide any information before an actual claim.

Not that I want to defend my chemo place, but the figures I posted were what they bill to insurance, not the lower contracted rates the insurance company will pay or which I hope they'll charge me if it comes down to self-pay. I'm calling tomorrow on the EOB's and may have to wait another week to see if they cover chemo.

I'm so glad Aloxi worked for you!  I'm posting separately on that...

I had the lab charge one blood draw to my mental health insurance! (The blood draw was NOT for any psych drug levels.) Maybe that was combat pay :-).