Lupron Cost - for Those Who Have Lupron Shot

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nancy2013
nancy2013 Member Posts: 7
edited September 2016 in Hormonal Therapy - Before, During, and After

I'm just curious. How much did you pay/are you paying for the Lupron shots? I just received my first bill for the Lupron shot for April. OMG, my portion is close to $1,400 for one shot. The insurance company paid for more than $3,000. I'm wondering if there is something wrong? I will be definitely broken if I have to pay it every month. The reason I need to take the Lupron shot is that the Tamoxifen doesn't work on me, or it was not metabolized based on the blood test result.

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  • Cuetang
    Cuetang Member Posts: 575
    edited June 2014

    nancy2013--that totally sucks!  But to answer your question about my experience, I pay my $35 copay for the shot--I get it monthly.  I think my doctor tries to charge the insurance over $1k for the shot, but ends up getting a couple hundred dollars.  Any way to ask the insurance company folks about your plan and the specific costs for it?

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  • jbdayton
    jbdayton Member Posts: 700
    edited June 2014

    Call your your drug insurance company and discuss if there are other options.

     During chemo if I got my Neulasta drug by the doctor it would have cost about $4400.00 but if I had the prescription sent to my house on ice overnight from the drug insurance specialty drug division it cost me $38.00.  I then gave myself the shot.  The first shot in the mail my GP had me come to his office and they walked me through giving myself the shot.  I was scared to death of messing up such an expensive shot.  

    I heard some ladies saying their bill was for up to $7000 per shot.  The numbers are all over the place.

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  • MoodyMoo
    MoodyMoo Member Posts: 30
    edited June 2014

    I still don't know what I will end up paying.  My insurance is still at odds with the MO about using Lupron to treat LCIS as I can't take Tamoxifen anymore.  So I have 6 months of injections still pending with insurance this year.

    I have no copays with my plan, it's an 80/20 up to a cap.  I can tell you that what I expect to happen is very similar to Cuetang.  They'll bill around $1000, settle for a couple of hundred, but I'll have to pay 20% until I reach my out of pocket max for the year.  

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  • nancy2013
    nancy2013 Member Posts: 7
    edited June 2014

    thanks a lot for all your input. I called my BlueCross insurance company and didn't really get a good answer. The lady told me that I need to pay 30% of the drug cost until I reach my maximum out of pocket fee. The hospital where my onco is billed approximately $13,000 for one-month Lupron shot. the insurance allowance is in $4k, so my portion is about $1,400.  Yesterday I went to see my onco to get the shot for the third times. I complained the drug cost and asked him if there was anything wrong. My onco was surprised also. He asked me to call the hospital's billing department. It's really a headache and frustration to call everywhere. I guess my insurance company should be on my side because they would definitely have not paid that much if there was something wrong, but they paid, which means the bill should be correct. How possible it is that one-month Lupron shot could cost $13,000 as the hospital billed! Maybe there is still something wrong.

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  • Moderators
    Moderators Member Posts: 25,912
    edited June 2014

    Nancy, please check out the Paying for Your Care section of the main Breastcancer.org site, specifically the Tips to Lower Medicine Costs article. It outlines info about Medicine Assistance Programs set up by many pharmaceutical companies (including Abbott Laboratories that makes Lupron) to help patients get the medicine they need at reduced cost, and sometimes no cost.

    There are other organizations listed there too that are set up to help with these high costs - there is help out there!

    • The Mods

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  • ChemicalWorld
    ChemicalWorld Member Posts: 172
    edited August 2014

    Late to this topic but wanted to chime in and encourage anyone getting expensive meds like this to definitely at least try some leads through your patient navigator, local BC orgs and such for assistance. 

    Having had the experience with Neulasta and the victory program, when I was prescribed Lupron and found out it was going to cost me $90 a month just for the copay alone (that is 20%), I started making some enquiries.  I will note I am in Canada.  It took me a few weeks, but eventually I was linked up with something called the Lupron Comfort Program that I was able to apply for.  Initially I was told I didn't qualify for programs because Lupron's main use was for men with prostate cancer.  I made a few more calls and got success.  I did have to fill out some forms, disclose info etc, but I am getting assistance with the cost.  Drug companies want to get their meds out there and this is one of the ways they do it. 

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  • purplelei
    purplelei Member Posts: 22
    edited August 2014

    Nancy2013, what was the end result of your Lupron shot cost issue?

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  • Merymete
    Merymete Member Posts: 31
    edited May 2016

    Old topic but had to chime in. My Lupron 3 month, 11.5 mg injection was billed to insurance at $16,790. Yup, you read that right. Insurance pays up to just under $5,000 for it. Thank goodness I've hit my maximum out-of-pocket costs for this year!!!

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  • Smurfette26
    Smurfette26 Member Posts: 730
    edited May 2016

    Wow that kind of greed makes me so angry. Also so grateful that here in Australia we have universal health care. My Neulasta injections cost me $38 and my breast nurse travelled 70 klms each way to administer it the day after my chemo. Free of cost of course. I had no out of pocket expenses at all for my surgery and I have no private health cover.

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  • superius
    superius Member Posts: 340
    edited September 2016

    Interesting how different Insurance work. I am NOT on Lupron (but it might be an option); & hopefully won't need it ....

    But during chemo I had Neupogen. I also had PICC line, which I had to go & get the dressing change weekly. One of the nurses asked how much I paid for the Neupogen (I did the shots at home). I told her it's $5 per shot ($25 each round of chemo). She told me that if I went in to have it administrated by a nurse, it's free. (billing statement said it's about $550 per shot!!!)

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