› Forums › General Melanoma Community › Stage 3 options ~ trying to understand insurance coverage
- This topic has 21 replies, 6 voices, and was last updated 7 years, 9 months ago by
slh4448.
- Post
-
- July 18, 2016 at 9:58 pm
Sorry to be posting again but I have more questions ….
background Stage 3a ~ do not qualify for clinical trial, only 1 lymph node positive, BRAF negative
was told interferon was my only option
was told I "don't want to do Yervoy, Stage 3 dosage too toxic"
I called my insurance company to see if any adjuvant therapy is covered by my insurance.
Yervoy ~ 10 ml is covered but needs pre-authorization
Keytruda ~ covered, no pre-authorization needed, $25 for 21 day supply
Opdivo ~ covered, no pre-authorization needed, $25 for 21 day supply
Am I mising something??
- Replies
-
-
- July 18, 2016 at 11:31 pm
As we talked before, I went through the same thing. I am not sure which avenue is the best as far as immunotherapy treatments but your Dr. is saying like mine did, interferon is the only option when it obviously isn't.
I have heard the horror stories about interferon with no data that it is beneficial. I can only say how I felt.
If yervoy was my best option at being NED or increasing OSR then I want to at least try it. If it makes me sick or I can't tolerate it then let's go to plan b. I don't want to start with plan b. I would never presume to tell anyone which choice to make but if you feel strong enough about one of the immunotherapies, then stand by it.
My Dr. said yervoy 10 mg is too toxic, I finally said late stage melanoma is more toxic. Finally he respected my wishes for my choice of treatment. I do not know if I am a responder yet. But I do know that interferon was not going to help. i have been in your shoes but my Dr. can't believe I finished 3 treatments. Stick to your guns and maybe you may seek another Dr. Good luck!!
And no, you are not missing anything!!!
-
- July 18, 2016 at 11:31 pm
As we talked before, I went through the same thing. I am not sure which avenue is the best as far as immunotherapy treatments but your Dr. is saying like mine did, interferon is the only option when it obviously isn't.
I have heard the horror stories about interferon with no data that it is beneficial. I can only say how I felt.
If yervoy was my best option at being NED or increasing OSR then I want to at least try it. If it makes me sick or I can't tolerate it then let's go to plan b. I don't want to start with plan b. I would never presume to tell anyone which choice to make but if you feel strong enough about one of the immunotherapies, then stand by it.
My Dr. said yervoy 10 mg is too toxic, I finally said late stage melanoma is more toxic. Finally he respected my wishes for my choice of treatment. I do not know if I am a responder yet. But I do know that interferon was not going to help. i have been in your shoes but my Dr. can't believe I finished 3 treatments. Stick to your guns and maybe you may seek another Dr. Good luck!!
And no, you are not missing anything!!!
-
- July 18, 2016 at 11:31 pm
As we talked before, I went through the same thing. I am not sure which avenue is the best as far as immunotherapy treatments but your Dr. is saying like mine did, interferon is the only option when it obviously isn't.
I have heard the horror stories about interferon with no data that it is beneficial. I can only say how I felt.
If yervoy was my best option at being NED or increasing OSR then I want to at least try it. If it makes me sick or I can't tolerate it then let's go to plan b. I don't want to start with plan b. I would never presume to tell anyone which choice to make but if you feel strong enough about one of the immunotherapies, then stand by it.
My Dr. said yervoy 10 mg is too toxic, I finally said late stage melanoma is more toxic. Finally he respected my wishes for my choice of treatment. I do not know if I am a responder yet. But I do know that interferon was not going to help. i have been in your shoes but my Dr. can't believe I finished 3 treatments. Stick to your guns and maybe you may seek another Dr. Good luck!!
And no, you are not missing anything!!!
-
- July 19, 2016 at 1:15 am
Regarding Yervoy at stage 3 the approved dose is 10mg/kg based on study results on stage 3. Your doctor still has the option to lower the dose down to 3mg,/kg.
Opdivo and Keytuda are not approved by the FDA for stage 3 and your insurance will not cover it. 4 infusions of Yervoy cost $120,000 so I do not think you will have only a $25 deductable per dose. There are additional costs to your treatment like infusion room at $1000-$1500 per dose, blood tests and doctor exams after every treatment. You will also require scans 3-6 month periods.
This is just the minimum costs as long as you do not have side effects. If the Yervoy damaged a gland or damages an organ you will be looking at some long term care costs.
Stage 3b melanoma has a 50/50 chance or recurance. Interferon will not cure your cancer nor will it stop recurance. Standard chemo would not be a good idea. You do not have anything to treat with radiation.
Your only option is interferon or Yervoy or just do nothing and visit your dr every 3 months.
Tom
-
- July 19, 2016 at 2:27 am
That is how my Dr. explained exactly. I forgot to mention he did try to get me to take a reduced dosage as you mentioned. He read the standard odds etc. as you stated. My options were: 1:Do nothing-2: interferon or 3:yervoy. I wasn't sure about the other options.
-
- July 19, 2016 at 3:15 am
Lee, you can also look at getting into a clinical trial of Pd-1 drug!!!Ed
-
- July 19, 2016 at 3:15 am
Lee, you can also look at getting into a clinical trial of Pd-1 drug!!!Ed
-
- July 19, 2016 at 3:15 am
Lee, you can also look at getting into a clinical trial of Pd-1 drug!!!Ed
-
- July 19, 2016 at 2:27 am
That is how my Dr. explained exactly. I forgot to mention he did try to get me to take a reduced dosage as you mentioned. He read the standard odds etc. as you stated. My options were: 1:Do nothing-2: interferon or 3:yervoy. I wasn't sure about the other options.
-
- July 19, 2016 at 2:27 am
That is how my Dr. explained exactly. I forgot to mention he did try to get me to take a reduced dosage as you mentioned. He read the standard odds etc. as you stated. My options were: 1:Do nothing-2: interferon or 3:yervoy. I wasn't sure about the other options.
-
- July 19, 2016 at 4:11 am
Pricing all depends on your insurance and also there are programs you can sign up for to get the drugs for free through the pharmacutical company. My onc automatically signed me up for that, so I have not paid a since penny for Yervoy. I pay $130 every time I get an infusion, the cost of infusion room. $35 for the full blood panel every time. And $70 to see my onc before the infusion. Most expensive thing are the PET/CT scans, which run me $450 each time. I am SO glad I was "lucky" enough to get diagnosed in November when it was time to decide whether to keep my current health insurance or switch. I switched and I pay a higher premium, but it's incredibly less expensive than if I had my other insurance which did not cover much. Bottom line, any major diagnosis is going to cost a lot of money, but there are ways around the massive price tags usually.
Also, the doctor is not the one to always call the shots on whether the patient gets 10mg or 3mg. Some doctors have been successful with fighting insurance companies for the patient to get them on the lower dose, but it's really up to the insurance company to approve it.
-
- July 19, 2016 at 4:11 am
Pricing all depends on your insurance and also there are programs you can sign up for to get the drugs for free through the pharmacutical company. My onc automatically signed me up for that, so I have not paid a since penny for Yervoy. I pay $130 every time I get an infusion, the cost of infusion room. $35 for the full blood panel every time. And $70 to see my onc before the infusion. Most expensive thing are the PET/CT scans, which run me $450 each time. I am SO glad I was "lucky" enough to get diagnosed in November when it was time to decide whether to keep my current health insurance or switch. I switched and I pay a higher premium, but it's incredibly less expensive than if I had my other insurance which did not cover much. Bottom line, any major diagnosis is going to cost a lot of money, but there are ways around the massive price tags usually.
Also, the doctor is not the one to always call the shots on whether the patient gets 10mg or 3mg. Some doctors have been successful with fighting insurance companies for the patient to get them on the lower dose, but it's really up to the insurance company to approve it.
-
- July 19, 2016 at 4:11 am
Pricing all depends on your insurance and also there are programs you can sign up for to get the drugs for free through the pharmacutical company. My onc automatically signed me up for that, so I have not paid a since penny for Yervoy. I pay $130 every time I get an infusion, the cost of infusion room. $35 for the full blood panel every time. And $70 to see my onc before the infusion. Most expensive thing are the PET/CT scans, which run me $450 each time. I am SO glad I was "lucky" enough to get diagnosed in November when it was time to decide whether to keep my current health insurance or switch. I switched and I pay a higher premium, but it's incredibly less expensive than if I had my other insurance which did not cover much. Bottom line, any major diagnosis is going to cost a lot of money, but there are ways around the massive price tags usually.
Also, the doctor is not the one to always call the shots on whether the patient gets 10mg or 3mg. Some doctors have been successful with fighting insurance companies for the patient to get them on the lower dose, but it's really up to the insurance company to approve it.
-
- July 19, 2016 at 1:15 am
Regarding Yervoy at stage 3 the approved dose is 10mg/kg based on study results on stage 3. Your doctor still has the option to lower the dose down to 3mg,/kg.
Opdivo and Keytuda are not approved by the FDA for stage 3 and your insurance will not cover it. 4 infusions of Yervoy cost $120,000 so I do not think you will have only a $25 deductable per dose. There are additional costs to your treatment like infusion room at $1000-$1500 per dose, blood tests and doctor exams after every treatment. You will also require scans 3-6 month periods.
This is just the minimum costs as long as you do not have side effects. If the Yervoy damaged a gland or damages an organ you will be looking at some long term care costs.
Stage 3b melanoma has a 50/50 chance or recurance. Interferon will not cure your cancer nor will it stop recurance. Standard chemo would not be a good idea. You do not have anything to treat with radiation.
Your only option is interferon or Yervoy or just do nothing and visit your dr every 3 months.
Tom
-
- July 19, 2016 at 1:15 am
Regarding Yervoy at stage 3 the approved dose is 10mg/kg based on study results on stage 3. Your doctor still has the option to lower the dose down to 3mg,/kg.
Opdivo and Keytuda are not approved by the FDA for stage 3 and your insurance will not cover it. 4 infusions of Yervoy cost $120,000 so I do not think you will have only a $25 deductable per dose. There are additional costs to your treatment like infusion room at $1000-$1500 per dose, blood tests and doctor exams after every treatment. You will also require scans 3-6 month periods.
This is just the minimum costs as long as you do not have side effects. If the Yervoy damaged a gland or damages an organ you will be looking at some long term care costs.
Stage 3b melanoma has a 50/50 chance or recurance. Interferon will not cure your cancer nor will it stop recurance. Standard chemo would not be a good idea. You do not have anything to treat with radiation.
Your only option is interferon or Yervoy or just do nothing and visit your dr every 3 months.
Tom
-
- July 19, 2016 at 5:47 am
Hello Laulamb,
Echoing Jenn above, the cost of treatment, including the very expensive Yervoy and most all the common melanoma drugs and immunotherapy, is entirely dependent on the insurance coverage you have. As a stage IV patient, I knew I would be a "heavy user" of the system, from the drug therapies, to the numerous scans, visits, tests, and other drugs/charges. I purchased the top of the line platinum plan and literally everything is covered virtually 100% after you pay the maximum out-of-pocket expense outlined in the policy. My premiums went up dramatically this past year, as well as doubling the the out-of-pocket threshold. But no matter, once you reach the threshold (for me it's simply the first infusion of the year) I am covered 100% for everything after that. Yes premiums are high, but compared to the cost of treatment its a no-brainer. Of course the very ill are the reason everyone's premiums are rising but the fact we can even buy insurance is the silver lining in the ACA.
Most important is making the right treatment choice which is Interferon or Yervoy for Stage 3. If you have been reading here you should know the choice is clear.
Gary
-
- July 19, 2016 at 5:47 am
Hello Laulamb,
Echoing Jenn above, the cost of treatment, including the very expensive Yervoy and most all the common melanoma drugs and immunotherapy, is entirely dependent on the insurance coverage you have. As a stage IV patient, I knew I would be a "heavy user" of the system, from the drug therapies, to the numerous scans, visits, tests, and other drugs/charges. I purchased the top of the line platinum plan and literally everything is covered virtually 100% after you pay the maximum out-of-pocket expense outlined in the policy. My premiums went up dramatically this past year, as well as doubling the the out-of-pocket threshold. But no matter, once you reach the threshold (for me it's simply the first infusion of the year) I am covered 100% for everything after that. Yes premiums are high, but compared to the cost of treatment its a no-brainer. Of course the very ill are the reason everyone's premiums are rising but the fact we can even buy insurance is the silver lining in the ACA.
Most important is making the right treatment choice which is Interferon or Yervoy for Stage 3. If you have been reading here you should know the choice is clear.
Gary
-
- July 19, 2016 at 5:47 am
Hello Laulamb,
Echoing Jenn above, the cost of treatment, including the very expensive Yervoy and most all the common melanoma drugs and immunotherapy, is entirely dependent on the insurance coverage you have. As a stage IV patient, I knew I would be a "heavy user" of the system, from the drug therapies, to the numerous scans, visits, tests, and other drugs/charges. I purchased the top of the line platinum plan and literally everything is covered virtually 100% after you pay the maximum out-of-pocket expense outlined in the policy. My premiums went up dramatically this past year, as well as doubling the the out-of-pocket threshold. But no matter, once you reach the threshold (for me it's simply the first infusion of the year) I am covered 100% for everything after that. Yes premiums are high, but compared to the cost of treatment its a no-brainer. Of course the very ill are the reason everyone's premiums are rising but the fact we can even buy insurance is the silver lining in the ACA.
Most important is making the right treatment choice which is Interferon or Yervoy for Stage 3. If you have been reading here you should know the choice is clear.
Gary
-
- July 20, 2016 at 10:01 pm
Hi,
Sorry about your diagnosis and the information that you were given regarding a clinical trial. I was curious if you are willing to say but why were you denied admission into a clinical trial? Was it because of 1 positive lymph node and a negative BRAF I'm assuming?? Also, where did you try to go to try and start on a clinical trial? If you're not comfortable saying I understand.
I ask because I have a "new" friend here in KC that is a business collegue of my brother. Her husband has melanoma and I believe it might be stage four but I don't know for sure and he may have more lymph nodes affected??? But he is in a trial involving immunotherapy that MD Anderson has initiated and designed, yet her husband receives the therapy here at KU Hospital per the protocol set forth by MD Anderson.
Just curious and willing to try and get some feedback from my friend for you if you would like regarding how the approval for clinical trials work, etc. Just let me know….
Stacy
-
- July 20, 2016 at 10:01 pm
Hi,
Sorry about your diagnosis and the information that you were given regarding a clinical trial. I was curious if you are willing to say but why were you denied admission into a clinical trial? Was it because of 1 positive lymph node and a negative BRAF I'm assuming?? Also, where did you try to go to try and start on a clinical trial? If you're not comfortable saying I understand.
I ask because I have a "new" friend here in KC that is a business collegue of my brother. Her husband has melanoma and I believe it might be stage four but I don't know for sure and he may have more lymph nodes affected??? But he is in a trial involving immunotherapy that MD Anderson has initiated and designed, yet her husband receives the therapy here at KU Hospital per the protocol set forth by MD Anderson.
Just curious and willing to try and get some feedback from my friend for you if you would like regarding how the approval for clinical trials work, etc. Just let me know….
Stacy
-
- July 20, 2016 at 10:01 pm
Hi,
Sorry about your diagnosis and the information that you were given regarding a clinical trial. I was curious if you are willing to say but why were you denied admission into a clinical trial? Was it because of 1 positive lymph node and a negative BRAF I'm assuming?? Also, where did you try to go to try and start on a clinical trial? If you're not comfortable saying I understand.
I ask because I have a "new" friend here in KC that is a business collegue of my brother. Her husband has melanoma and I believe it might be stage four but I don't know for sure and he may have more lymph nodes affected??? But he is in a trial involving immunotherapy that MD Anderson has initiated and designed, yet her husband receives the therapy here at KU Hospital per the protocol set forth by MD Anderson.
Just curious and willing to try and get some feedback from my friend for you if you would like regarding how the approval for clinical trials work, etc. Just let me know….
Stacy
-
- You must be logged in to reply to this topic.