Cost of Temodar has gone up - Insurance claims it has benn reformulted

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Cost of Temodar has gone up - Insurance claims it has benn reformulted

by Tulsatom on Sun Sep 02, 2007 12:00 AM

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We have been purchasing Temodar each month for $25 using our co-pay with Blue Cross - now they tell us that the drug has been reformulated and we are responsible for 30% of the cost which is over $800 - they also did the same thing to her nausea drug in the same month so we went from a $50 bill to over a $1000 bill each month. Is anyone else runinng into this?

RE: Cost of Temodar has gone up - Insurance claims it has benn reformulted

by Osborne on Mon Sep 03, 2007 12:00 AM

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We had aletter from United Health Care. If we get Temadar again it would have to be from their "special pharmacy" whatever that is. They would not pay for it from our local drug store. We never did have to have it again because my husband is now going to take avastin and cpt11.

RE: Cost of Temodar has gone up - Insurance claims it has benn reformulted

by Wreed on Mon Sep 03, 2007 12:00 AM

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We ran into the same problem.  What they usually meany by special pharmacy is mail order. If you try to get it filled at a regular Rx, it will most likely cost a fortune.  Our NO uses a mail order Rx, which is considerably less.  I think my mom is getting the Temodar for $100 per month through Anthem blue acces.  They are also using the generic nasuea medication.  I think it is Zofran.  It might cost $10 per month.  The other Oncologist my dad was seeing was not very good or experienced.  She knew nothing about the mail order RX, so you might have to press harder and demand that they use it.  She was also prescribing a very expensive anti-nasuea medication that was going to be over $500.  I think it is called dytril or something like that.  The new NO that we see is much more experieced and said the Zofran will work just as well.  Make sure you doctors are not out for the money or kickbacks they can receive.  Unless you ask, you may not get good info.  Good luck!!  It is very stressful, and until we dug deeper, my mom was terrifed about the cost.  You should not have to worry about the reformulation if that did happen.  You can still get it for less. 

RE: Cost of Temodar has gone up - Insurance claims it has benn reformulted

by Houston_Wife on Tue Sep 04, 2007 12:00 AM

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I checked with United Health Care, our provider, and was told that there have been no changes in the price of Temodar.  My co-pay was still at $35.00.

With Blue Cross there may be an appeals process to help with this cost.  I wish you the best of luck with this.  It is appaling to me that the drug companies and the insurance companies would make it so difficult, and in some cases, impossible to help people who depend on these drugs for there survival.

 

RE: Cost of Temodar has gone up - Insurance claims it has benn reformulted

by Donna610 on Tue Sep 04, 2007 12:00 AM

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my sister has had difficulty w/Blue Cross since her diagnosis.  The latest is that they required her to recieve the Temodar via mail, rather than from her usual pharmacy.  Also, the oncologist has to have the prescription "authorized" each and every month.  Just what exactly do they think she's doing with Temodar?  And, they've already denied coverage for Avastin.  Bottom line is the insurance companies don't want to pay claims...the don't make money that way.

RE: Cost of Temodar has gone up - Insurance claims it has benn reformulted

by Madeline_Ruth on Tue Sep 04, 2007 12:00 AM

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This is absolutely infuriating! I am a pharmacist and I just can't believe these insurance companies. Why would anyone be able to get chemo in the mail? This is a drug that may or may not be given the following month---based on labwork. You don't have 11-14 days to reorder through the mail, and take a chance on not receiving the drug. Are those who are receiving this mail order, receiving a package that is shipped on dry ice or is there a marking on the exterior of the package that designates this to be a BIOHAZARD??? Are you getting it shipped overnight? Please let me know. I am ready to fight on this one. Schering also needs to be involved in this fight with insurance companies. At a time when people are going through something so awful, as a brain tumor, why should we have to deal with these insurance issues. This is the time in life that we need the local pharmacist most because there are many needs throughout this journey. I'm so sorry that you all are having to deal with these insurance companies and their failures. Temodar has not been reformulated. There is some discussion that a generic will be released very soon, but that's all. Hang in there to all!

RE: Cost of Temodar has gone up - Insurance claims it has benn reformulted

by bpanc on Tue Sep 04, 2007 12:00 AM

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My husband was on Temodar for 42 days at the same time he was receiving radiation.  My company healthcare plan uses Caremark. My husband's oncologist called and ordered the Temodar, Caremark shipped it to us (next day air) from their specialty pharmacy in Illinois.  They only sent us enough for the first 30 days but told me to call them when we had enough left for about a week.    I did, and they then shipped out the remaining 12 days worth of pills.  It was effortless and cost me my $60 co-pay ($60 for the first 30 days and another $60 for the last 12 days).  

RE: Cost of Temodar has gone up - Insurance claims it has benn reformulted

by RosaDawn on Wed Sep 05, 2007 12:00 AM

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My Dad's Temadar has not gone up but they would not let him have it on the mail program.  He has Blue Cross and they made him go to another sick med after the first month.

Rosa (Dad dx 02/07) 

 

RE: Cost of Temodar has gone up - Insurance claims it has benn reformulted

by Sharon_D_2 on Thu Sep 06, 2007 12:00 AM

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Our Blue Cross/Blue Shield is through my husband's work.  When he was diagnosed, the human resources manager gave me information on a health care advocacy business, which is the inbetween  for the ill patient and dealing with the insurance company.  Perhaps you may be entitled to an organization like that as well.  They have given me some direction when my husband returned home from surgery.  At that time I was overwhelmed at the thought of what lies ahead with drastic life changes, immediate loss of income, and how will we survive.   

The 2nd prescription of Temodar had to come through Caremark (mailorder), and there was no problem.  Our oncologist was familiar with the system.  All the other drugs were able to be picked up at the local pharmacy.  It doesn't make any sense to me, we just have to play the game (which I dread, there's enough on our plate as caregivers besides being put on hold with insurance companies and long distance drug suppliers).  If I had a full-time job, I'd never have the time to take care of these issues on the phone. 

Keep asking questions, eventually answers are received.  Good Luck.

Hugs to all the caregivers,  Sharon D. 

 

RE: Cost of Temodar has gone up - Insurance claims it has benn reformulted

by gardenbug on Tue Mar 06, 2012 01:15 PM

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We just went to pharmacy to get Temodar and also found that Blue Cross charged us $800 for on prescription, I am not thinking this drug will break us and what else are they going to do to us now??? But they deducted it from our yearly out of pocket fee of $1500 for the year, and next month, although it is a lot to bite off in one month, I will pay the entire yearly out of pocket off. Then from now on, I will not have to pay anything for medical the rest of the year. So, see if they deducting this amount from your yearly out of pocket, which may mean that after so much, you don't have to pay anything for medical the rest of the year. Still though, hard to believe that anyone would have to pay such horrible fees up front for these types of medications, it drains you, financially and emotionally to have to go through all of it. Hope this helps, because most insurance companies do not even bother to explain to you that they high co pays for drugs come off your yearly out of pocket. Crazy fees for medical drugs!  

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