Yesterday I got a more comprehensive bill for Rituxan infusion treatment that makes somewhat more sense than the previous summaries and payment demands.
Yes, it is criminally expensive treatment, far more expensive than I was told it would be, more than $46,000 vs $4,600, but what's billed and what's paid are completely different things, and as far as I can tell, the $46,000+ figure billed is nonsense, a place-holder at best, a figment of imagination mostly.
The more comprehensive bill (which says "This is not a bill" just to keep me on my toes) includes all the labwork and the preliminary medications (in case I had a reaction) and the various "pushes" to get the Rituxan into me. It includes the charges for all of this and how much the "Plan" paid for various things. Interestingly, the "Plan" paid nothing for most of it, and I will have no co-pay for it either.
Well, that's a relief, right?
But all these charges add up to get to the $46,000+ figure, and it looks to be little more than bill-padding. Something that has a long and inglorious history in the practice of medicine.
Where it gets interesting is the charge for Rituxan itself.
I thought that 5mg were being administered each time I had the infusion, but according to the bill ("This is not a bill") it was actually 50mg, and each time I had the infusion, the charge for Rituxan was $21,202.
However. The "Plan" allowed $9,492 for Rituxan and paid $8,543, leaving me with a 10% co-pay for the drug each time, or $949, which adds up to $1,898.
And literally, that is all I am being billed for. Everything else is covered by the "Plan."
Well, who knew?
Obviously those who tried to find out for me didn't and couldn't.
We'll see what the charge actually ends up being when all is said and done. While Ms. Ché and I have too much income to qualify for Medicaid, our income is low enough (so I understand, but who knows) to qualify for financial assistance from the hospital, and I've applied for that. According to what I've been told, if the application is approved, the co-pay/cost sharing will be cut in half.
Nevertheless, I'm stunned at the cost for 100mg of Rituxan. It's outrageous, beyond belief truthfully, yet I'm sure there are plenty of drugs on the market which I don't know about that cost quite a bit more.
We know PhARMA has zero social conscience, but still, my question is why do "Plans" pay these outrageous amounts? How much mutual back scratching is built in to this system? Who benefits? Who ultimately pays?
And what can we do about it?