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Thread: Rituximab co-pay programs

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    Default Rituximab co-pay programs

    Has anyone used the Genentech Rheumatology Co-Pay Card Program?
    Or any other program to help with the cost of the Rituximab infusions?
    Any advice is appreciated.
    Thanks! Lucy

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    I'm fortunate to have excellent health insurance - Aetna Medicare PPO. I must get pre-approval for rtx and my co-pay is $25.00. Insurance gets billed for about $20,000.

    Others here have used the card which cuts the cost pretty dramatically. It's definitely worth a shot.
    Pete
    dx 1/11

    "Every day is a good day. Some are better than others." - unknown

    "Take your meds as directed and live your life as fully as you can." - Michael Chacey, MD

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    Lucy,

    I have used the Genentech copay program. The hospital where I got the infusions called me to sign me up for the program - I simply had to agree over the phone. After that, whenever I get an infusion, the insurance company pays what it normally would and the hospital charges the copay to the Genentech program. (I did get a bill for the copay and when I called the hospital they said to ignore it.) It was all very convenient. Also the copay amount counts towards the maximum out-of-pocket expense, so it's really cash back! The card is good for about $12000 for a year or so - and the hospital took care to sign me up for a renewal before the expiry date.

    I would suggest you speak with your health care provider and make sure they sign you up, and also check that they will renew the card before it expires, as the program requires.

    Good luck!

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    A clarification: The Genentech co-pay covers only the cost of the Rituximab medication, not the solumedrol nor the benadryl that are given along with the RTX. It also does not cover the procedure costs of administering the drug. After 3 months, and the day after my reply above, I got a revised bill of about $800 for these items. Genentech covered $1000 for the drug itself, and my insurance paid several thousand. That's for one infusion.

    I learnt a lesson about billing procedures. Each item on the bill has a Revenue Code (revcode for short), and the items are sorted in order of the revcode. Had the RTX revcode been the lowest (and therefore the first item on the bill), the cost of the drug would have exceeded my deductible + co-insurance and Genentech would have covered all that. The rest of the items would haven't incurred out-of-pocket expenses (the deductible + co-insurance having been reached). Alas, the RTX revcode is the largest, so it ends up last on the bill, and I end up paying co-pays on the non-RTX items. That'll teach me to be greedy! On the plus side, it saved the Genentech foundation some money that will be used for other patients!

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