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Crohn's Disease Forum » Treatment » Entyvio/Vedolizumab » The cost of this medication...


10-08-2014, 08:29 AM   #1
CLCH87
 
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The cost of this medication...

Yesterday was my first infusion and I received my EOB this morning from Cigna. Not including the $1750 the doctor charges for doing the infusion I'm being billed over $14,000. Yes that's with three zeros. The "savings program offered by the manufacturer covers $6500 a year... Thankfully my out of pocket maximum is $3500 so I shouldn't pay more than that but is this really worth that much? And what about other people who don't have insurance? I find it crazy that they can charge this much. Has anyone else been charged this much? (BTW I attached a screen shot of the EOB, I had to wait three weeks from my last cimzia shot before starting Entyvio which is why it was billed in September.)
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10-08-2014, 08:58 AM   #2
DJW
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Wow!
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10-08-2014, 09:46 AM   #3
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10-08-2014, 10:53 AM   #4
tricia_c
 
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Yesterday was my first infusion and I received my EOB this morning from Cigna. Not including the $1750 the doctor charges for doing the infusion I'm being billed over $14,000. Yes that's with three zeros. The "savings program offered by the manufacturer covers $6500 a year... Thankfully my out of pocket maximum is $3500 so I shouldn't pay more than that but is this really worth that much? And what about other people who don't have insurance? I find it crazy that they can charge this much. Has anyone else been charged this much? (BTW I attached a screen shot of the EOB, I had to wait three weeks from my last cimzia shot before starting Entyvio which is why it was billed in September.)
Yikes, is that the amount you actually owe, or before insurance? My EOB breakdown from first infusion:

Amount Billed $20,408, includes:
Pharmacy $13345.60
Op Misc Services $6262.40
Infusion $800

Plan Discounts/Payments $19940.86

Amount I owe $467.14

Still waiting on Entyvio connect to factor in. This charge put me over my out of pocket, so my EOB for the second infusion shows I owe nothing.

These biologics are expensive! The amount billed for Remicade (drug only, not other infusion charges) was around $12,000.
10-08-2014, 12:06 PM   #5
CLCH87
 
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I'm not sure. I was on the mobile app so Idk if that's before the insurance discount or not. And I have no clue what I owe yet, it says processing where everything else says paid, which is strange. I was just in shock this morning lol
10-08-2014, 12:09 PM   #6
alex_chris
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Biologics for Crohn's are the biggest cash cows in the pharmaceuticals worldwide. Remicade and humira are the two most profitable drugs for any disease globally.

Let's see what happens with prices once biosimilars (generics) are more widely available and used. Currently I only know of a remicade biosimilar approved in the EU recently, not sure about what the costs are. I assume within the next 5 years prices for biologics for Crohn's are at least halved if not reduced further.
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10-08-2014, 12:31 PM   #7
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I am so so grateful for the NHS! It's awful to see how much healthcare costs people in so many other places, I don't know how you all manage it, and it still shocks me every time I read a post like this.

I had a course of IV meds recently and for some reason the price was written on the label - the NHS was paying something like 360 per day for this one med. I wouldn't have even thought about it if it hadn't been printed there. I try so hard not to take this for granted.
10-08-2014, 06:34 PM   #8
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Makes me wonder are most illnesses curable but aren't because of profits made by pharmaceutical companies?
10-09-2014, 04:53 AM   #9
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Makes me wonder are most illnesses curable but aren't because of profits made by pharmaceutical companies?
I think that's just a conspiracy. However, I have heard more convincing evidence (from someone who works in the pharmaceutical industry) that when it comes to getting funding for research, money dictates which diseases will get attention. E.g. developing medications to treat diabetes, a widespread condition affecting people in the Western world, is more profitable than developing treatments for conditions only prevalent in third world countries. But I believe developing a cure for a disease affecting rich populations - including Crohn's - would be very profitable, so I highly doubt that anyone is deliberately avoiding doing so.

And I'll say what I know I've said on this forum before: in the UK, it is in the government's interest to spend as little as possible on health care. So even if the pharmaceutical industry were trying to keep people sick, surely the UK government has some kind of influence that they would use to work against this?
10-09-2014, 05:54 AM   #10
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Whether its a conspiracy or not its just sad to have to worry about not being able to be treated because of cost issues. The decision for funding makes a lot of sense. There are many illnesses out there that Im not even aware of. Altough I have noticed that Crohns and UC have been receiving big press during the last year or so, I still get that weird look from people when I say my daughter has Crohns. They have no clue what that is. I have excellent insurance and pay an arm and a leg to insure my daughter gets whatever treatment is available. Yet, I still end up paying $$$& of out of pocket expenses and certain medications have not been covered. I know health care is a big issue in many places and its not a problem that can be resolved quickly. As far as what is in the government's best interest, unfortunately I'm one of those that dont have full faith on any government or any politician. Its hard to follow what is on the agenda today. Lol
10-09-2014, 10:29 AM   #11
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This is such a thorny issue. It doesn't take a full-blown conspiracy (i.e., people actively planning together) to cause these problems. Healers of most kinds from doctors to psychotherapists to alternative practitioners are indirectly rewarded by having their patients NOT get "cured," because then they lose income. I personally and sincerely believe that almost all practitioners have the best interests of their patients at heart, but it's a subtle influence on behavior to run the risk of putting oneself out of business by curing everyone.

A really tragic part as I see it is the colossal cost of doing the kinds of trials needed for FDA approval, which means that really only big businesses can do the kind of science needed to demonstrate scientific clinical outcomes. I really wish there was more money for research into alternative approaches like diet, acupuncture, medical marijuana, etc., so that we could have just and solid clinical outcome data as for pharmaceuticals. I find myself curious and even hopeful about some of these other approaches, but the empiricist in me really wants more data.

(End soapbox)
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10-09-2014, 10:37 AM   #12
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Very well said! Agree!!!!
10-15-2014, 01:33 PM   #13
Brian'sMom
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Our infusions (Vedo only) is 18,500. I wonder why the differences in the price that you all mentioned. Why wouldn't it be the same? That didn't even include the hospital charge for doing the infusion! I about choked!! We had surgery last March and our deductible is met.. so we're good for this year. I worry about next There is an assistance co pay program like with the TNF drugs.
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10-16-2014, 03:31 PM   #14
Axelfl3333
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This cannot be right I don,t care what anyone says about it,profit off sick people is wrong!our friends across the pond should be marching in the streets about this $18000 for two or three treatments!no chance there at it.our NHS has serious issues but ability to pay isn't,t one of them.on the conspiracy theory it's to big to keep quiet I,m afraid,I have a friend who works and is senior in a big hospital she says that joe public would be shocked at how little progress has been made over the last 20 years in medicine,sadly looking at news I think she,s right
10-16-2014, 09:50 PM   #15
Brian'sMom
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It was 18,500 for one, Axelfl3333! I thought Humira/Cimzia was expensive... Vedo makes it look cheap!! Crazy!
10-17-2014, 03:06 AM   #16
Axelfl3333
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I feel for you,it's not right or fair.
10-17-2014, 05:52 PM   #17
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For purposes of comparison, a guy on Remicade in the clinic today said his insurance statements show billing of $19500. What a racket...
01-17-2015, 08:06 AM   #18
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Without those evil pharmaceutical companies I'd have been dead for 20 years or, maybe, somehow living without a digestive tract. They have to pay for drug development somehow and will squeeze it out of anyone who has the money. It's an extraordinarily difficult process, with a researcher lucky if they participate in one successful development in their entire career. Then the studies and approval process eat into the patent protection period, limiting the ability to get a return on their investment. So please have some understanding for their position, because other systems, like government funding, just do not seem to produce significant new treatments.

BTW I passed on Entyvio because the study results for Crohn's did not seen to be worth the cost. Decided to stick with Humira even though its effects are declining for me after about 8 years on it.
01-17-2015, 08:29 AM   #19
lenny
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My husband's company is self-insured and even though they are a big company, I'd feel super guilty about using such an expensive drug. I already feel guilty about our recent 30K hospital stay.
09-18-2015, 03:33 PM   #20
Fernando1
 
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I was billed 4900 an infusion, need to pay the first 3200, the insurance pays the rest of the year, up to 30,000 for all.
11-02-2015, 07:09 PM   #21
devorahleah
 
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Have you tried the Entyvio connect copay assistance program?
I'm going to be having my first Entyvio infusion later this week, and have not yet been approved for this program ( but my doctor said that there's no reason not to be approved).
11-03-2015, 04:55 PM   #22
Fernando1
 
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We tried the Entyvio Copay program, I was making too much money (more than twice their maximum to qualify) so I was not approved for assistance.
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