Friday, August 22, 2008

I Heart Capitalism...

Just got off the phone with my "specialty pharmacy" company that supplies my Tysabri, who buys the product direct from the drug pharmaceutical company. My insurance company, who contracts with the "specialty pharmacy" company, pays said "specialty pharmacy" company a flat, negotiated rate for each vial of Tysabri:

$2,400.00 per vial

I put batteries in my calculator so I could get these figures right for you...wouldn't DARE rely on my MS brain to do simple calculations!

Tysabri is recommended to be administered every FOUR weeks (not necessarily monthly, as some proclaim), which means in a 364 day calendar year, that would be 13 doses. If my batteries haven't failed in the calculator, that is a cost FOR THE MEDICATION ALONE of $31,200.00 a year, which is far from inexpensive...but THAT's NOT my point. And I DO have one.

My neurologist's office billed my insurance (from the previous post rant) $3,708.00 dollars for one of my infusions there. OK...calculations get a bit more complex, but 13 x 3708.00 = $48,204.00.

CLUB MED (who continues to remain nameless and faceless here on CHEESE, lest they discover the utter bile-filled disgust I have with them right now and decide to infuse me with anti-freeze next Friday!) billed my insurance $12,785.70 for my infusion with THEM. (**grabs calculator again) 13 x 12,785.70 = $166,214.10. That's a difference of ONE HUNDRED EIGHTEEN THOUSAND TEN DOLLARS AND TEN CENTS. Need to see it in numbers?



Based on total infusion cost per year at my neurologist's office versus total infusion cost at CLUB MED, Tysabri COULD be costing my insurance company (which means YOU AND I indirectly) anywhere from $79,404.00 dollars per year and $197,414.10.

PERSONALLY, I KNOW I am worth more DEAD...


Tricia said...

Hmmm it is crazy for sure - so if your doctor's office was getting the medication from the specialty pharmacy what on earth was the $5k of charges for? And ditto the Club Med place?

When Pete got his med from the pharmacy at the one place they charged around $500.

Merelyme said...

OMG! holy pastrami batman! those are some big numbers there. it is incomprehensible to me. why does this stuff cost so much?


I like where you're going with this.

My 5-day short stays at Club IVSM Neuro in March were billed at $3900, but only $752 of which insurance said was "allowed." Even $225 of that was for the Solumedrol itself.

So how can a 4-hour supervised stint in the chair at your neuro's office cost almost $3000 when five 90-minute stints at mine only cost $530?

I understand the whole extra TOUCH stuff, but seriously does it have to cost equal to the drug itself?

Denver Refashionista said...

Yet another reason to feel jaded...

Merelyme said...

hey again! stop on over to my place...i wrote a little something about ya tonight. i am manic this evening and i can't stop blogging!