As you have been following my Rituxan story, I have been sharing information about my personal experience in receiving this infusion medication for RA, any reactions I had to the infusion (see part one), and any benefits I’ve seen from the infusions (see part two). This month I’d like to share the expenses involved.
Like many of us, I like to know the cost of something BEFORE I commit to purchasing. After receiving the ‘go-ahead’ from my rheumatologist and my neurologist for starting Rituxan treatment, I needed to find out what my out-of-pocket costs were going to be and find a pharmaceutical assistance program to help with those.
My first homework assignment was to find out which hospitals my insurance company would pay for outpatient infusion therapy and to discover if I needed a chemotherapy preauthorization ahead of time. A call to the insurance company came first and I was pleased to discover that each of the local hospitals were equally satisfactory to my insurance company. No preauthorization was necessary.
Then I discovered The RITUXAN for RA EXPERIENCE Program which provides eligible patients with $4000 per 12-month period in direct assistance to reduce the out-of-pocket costs of Rituxan. To apply I called the 1-888-697-4889 number.
While on the phone with the program representative, I asked about the cost of Rituxan itself. She didn’t know and suggested that the price was affected by insurance negotiations. So I called my insurance company again to ask the same question. With a 10 percent co-insurance, I wanted to know how far $4000 would go in covering out-of-pocket costs.
After a few more calls, I was quoted a cost of about $560 per vial (10 vials are required for infusion). Turns out that what my insurance paid the hospital was 75 percent higher than the price I was originally quoted. Yikes.
I don’t have an answer as to why the big difference, but 10 percent of $9800 is a whole lot more money than 10 percent of $5600. I'm so thankful that I could use the assistance program and that I don’t have a 20 percent or even 30 percent co-insurance requirement. Can you imagine?
To enroll in the program, I needed to sign and have my doctor sign a release form. Genetech/Biogen needed to make sure that I really qualify and have RA I suppose. The facility at which you receive your infusion is also supposed to enroll in the program, but fortunately there is a workaround if that is not the case (as in my own case).
My infusions were done in a hospital outpatient center and on the day of the 1st infusion I told a nurse that this program needed the hospital to enroll and the program needed to know the lot number on the vials of Rituxan. Of course, none of this was accomplished on that day so I called the assistance number while sitting in the hospital bed. I was told that after I received the hospital bill and my EOB (Explanation of Benefits) that I could fax her the information and they would send a check to the hospital (or me).