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Xeloda users

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Xeloda users

Postby maxum2199 » Sat Dec 04, 2010 12:45 pm

I know what I am asking is personal and if I get no replies I understand.Was just wondering what your co-pay is on the medication.Am new at this(first radiation after almost 5 years of fighting this).Was just informed my co-pay would be $147.00 for a 10 day supply.Guess I am just curious.Thanks.....................Randy
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Re: Xeloda users

Postby weisssoccermom » Sat Dec 04, 2010 12:57 pm

Randy,
Yes, Xeloda can be very expensive. When I was on it (4 years ago), very few insurance companies covered it with low copays. I believe mine was something in the range of $200/14 day supply. Fortunately, I had/have dual insurance so didn't worry about it. Now, however, most insurance companies cover Xeloda much like any other medication. If your copays are high, you should contact Roche as they have programs to help with the cost. There are also other agencies that can help as well.

http://www.cancercarecopay.org/eligibility.html
http://www.xeloda.com/hcp/xeloda-access-solutions.aspx

Hope these can help you out.

Jaynee
Dx 2006 IIA rectal cancer
6 wks rad/Xeloda
1st attempt transanal excision 11/06
11/17/06 XELOX 1 cycle
5 mths Xeloda only - blood clots 1/07
transanal excision 4/20/07 path-NO CANCER CELLS!
NED now and forever!
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Re: Xeloda users

Postby Surroundedbylove » Sat Dec 04, 2010 1:13 pm

My insurance was one that had three tiers - generic, name brand formulary, and non-formulary. The shelf cost of Xeloda was about $2,500 per cycle at the time I went through treatment. I was very thankful that my insurance had switched from a percentage payment after co-pay to a specific dollar amount. My co-pay was $10 for generic/$25 for name brand formulary/$50 for non-formulary. I paid $50 per cycle for the Xeloda ($50 total). If my insurance had not just changed it would have been our old insurance which was a co-pay of $10 for generic and then 25% for name brand formulary and 50% for non-formulary. My cost would have been $1,250 per cycle!

A couple of things to check - is it on the formulary? Can you do a mail order prescription that would be less expensive? Does you insurance include an annual out-pf-pocket maximum that also includes prescription drugs? If so, your treatment and drugs will probably quickly meet that maximum.
Surroundedbylove

Rectal Cancer @ 43, '08
Clinical: T3,N2a,MX (IIIB)
6 wks XELOX & radiation
LAR, colonic j-pouch, & temp ileo '09
Surgical: ypT3,ypN0,ypMX (0 of 20 nodes)
FOLFOX; XELOX
Ileo Takedown '09
SIL Dx 2014 - Rectal T3
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Re: Xeloda users

Postby RixInPhx » Sat Dec 04, 2010 1:21 pm

Your copay works out to $14.70/day = $7.35 per pill.

The 'standard' pill seems to be 500mg, and dosage is twice per day for 14 days (standard course of treatment) so make sure what you're pricing/talking about.
BUT, dosage can be 1000mg/pill (2000 per day); and there are some 'aggressive' treatments for breast cancer at 2000/dose, 4000 mg/day).
So for a 3 week treatment cycle with 14 days of pills and one week off for rest, you need 20 days/40 pills per month; basically a co-pay of $295/month :eek:

Cash price is $33.32/pill from an online Canadian drugstore, here: http://newyorkcostumes.com/store/xeloda ... ption.html

*Assuming* your insurance has worked out a pricing schedule with the local pharmacy where the net pricing is similar to the Canadian street price, then your co-pay of 7.35/pill = 25% of the pill cost.
The insurance would then be paying the other 75% (885/mo).

Definitely try to negotiate pricing with your insurance and with Roche (they actually have free 'scholarships' for the destitute, as well as other assistance programs).
Your cancer center should have a financial counselor who is skilled in making contacts and preparing paperwork.
* * *

There is an alternative, being 5-FU infusion every 14 days.
5-FU is pretty cheap (wholesale to the clinic pharmacy), but the clinic charges insurance a lot for the service; however, the co-pay to you might only be about $100/doctor visit.
This can be a negoiating point with the pharmacy, if your onc will consider that treatment.
Last edited by RixInPhx on Sat Dec 04, 2010 1:57 pm, edited 1 time in total.
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Re: Xeloda users

Postby lydia123 » Sat Dec 04, 2010 1:25 pm

We hit our annual cap. Nothing out of pocket. Nor for kytril. I was stunned. Of course, we're thousands of dollars in for the year...
lydia123
caregiver to husband dx stage III colon/rectal cancer 5/10
6/10 surgery
7/10: FOLFOX began -- became nausea management expert
12/10: Chemo-radiation ended, scans clean.
NED since, but some scans required follow-up
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Re: Xeloda users

Postby Surroundedbylove » Sat Dec 04, 2010 1:45 pm

RixInPhx wrote:Your copay works out to $14.70/day = $7.35 per pill.

The 'standard' pill seems to be 500mg, and dosage is twice per day for 14 days (standard course of treatment) so make sure what you're pricing/talking about..


Actually the standard number of pills given per dose is determined by the patient's weight - however I believe under most insurance the number of pills won't matter because they factor in that a prescription for one cycle for one person may be different than the number of pills per person for another patient.

Yes, twice a day for 14 days is the standard cycle.
Surroundedbylove

Rectal Cancer @ 43, '08
Clinical: T3,N2a,MX (IIIB)
6 wks XELOX & radiation
LAR, colonic j-pouch, & temp ileo '09
Surgical: ypT3,ypN0,ypMX (0 of 20 nodes)
FOLFOX; XELOX
Ileo Takedown '09
SIL Dx 2014 - Rectal T3
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Re: Xeloda users

Postby Gaelen » Sat Dec 04, 2010 1:53 pm

my copay for 25 days of Xeloda was over $500 in 2008.

Worse, Caremark - the online pharmacy my pharmacetical research company uses for its prescription coverage - has a similar "tier" system. Name brand drugs can't be purchased more than 3x from a brick and mortar pharmacy, or you have to pay 100% of the cost. My normal copay is $15 or 10% of cost, whichever is greater. Even my pharmacy can't believe how expensive this plan is. But oral chemo drugs like Xeloda have to be, can only be, ordered directly from them to get their lowest copay of approximately $5/pill. I didn't have that option - my oncologists ordered Xeloda for me on a Friday afternoon, Dec 21. I needed my first dose Monday morning, Dec. 24. By the time I got to the pharmacy to fill the script after work, it was close to 8pm. Caremark denied it, I called them, and they insisted that they could get the drugs to me before my first rad treatment on Monday at 7:30am. I said, "the weekend before Christmas? yeah, right. My brick and mortar pharmacy has it in stock and you're covering it, and if I have to contact the company president, I will."

They approved the scrip, but it's a good thing I had $500 to cover the copay.
Be in harmony with your expectations. - Life Out Loud
4/04: dx'd @48 StageIV RectalCA w/9 liver mets. 8 chemos, 4 surgeries, last remission 34 mos.
2/11 recurrence R lung, spinal bone mets - chemo, RFA lung mets
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Re: Xeloda users

Postby blakeswife » Sat Dec 04, 2010 2:33 pm

My husbands company has their own pharmacy and our co-pay was still $200. Our prescription coverage doesn't have an annual cap but, after the deductible was met, they didn't charge us anything. So, if Blake has to go on Xeloda in the future, I hope it's after the deductibles are met! That should be taken care of my the 2nd week of January! :wink: Deductibles = UGH!!
DH Stage IV 10/07
Colectomy, Liver resection & RFA, 1/13 LN
12/07-5/08 Folfox/Avastin
7/09 recurrence-Peritoneum
9/09-12/09 Folfiri/Avastin
1/10-5/10 Xeloda/Avastin
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Re: Xeloda users

Postby weisssoccermom » Sat Dec 04, 2010 2:46 pm

RixInPhx -
SBL is quite right. The dosing of Xeloda is based on body surface area - a combination of weight and height and so each person is different as to how many mg/day he/she takes. In addition, there are only two different strengths of Xeloda - 150mg and 500 mg. If, for example, a person is taking 2000 mg a day, that would equate to 4 of the 500 mg pills each and every day & the amount of copay is based on the script. The dosing that you mention don't have anything to do with being aggressive. Besides dealing strictly with the height/weight issues, dosing varies depending on whether or not the patient is also doing radiation at the same time. In other words, a patient will be on a lower Xeloda dose during rad treatments than he/she would be strictly doing Xeloda alone.

Furthermore, you need to understand that while 5FU infusion is an option during chemoradiation, it is not generally considered standard anymore. Yes, other factors, such as insurance, patient compliance must be taken into consideration, most patients on radiation would much prefer the pills over a constant 24/7 infusion of 5FU for 6 weeks duration (standard protocol for rectal cancer). This is NOT the same as a 48 infusion of 5FU in the FOLFOX protocol. Being hooked up to a pump 24/7 for 6 weeks is not fun. I know that some people do it and my hat is off to them. I went bonkers after one week on that dang pump. Also, keep in mind that during that same time frame (6 weeks) the patient must go to the infusion clinic every week for a pump change, flush and new needle insertion. The tape begins to itch, the pump is in the way - overall, a pain in the you know what!

Randy, there are options out there for you. In addition, ask your onc about any 'samples' or 'extras' that he may have in his office. Many of us have had extra Xeloda pills that we have 'donated' back to the onc clinic & they in turn dispense them for patients who didn't have insurance, couldn't get the pills in time or who have high copays.

As SBL states - if you have mail order on your insurance plan, see what the copay would be there. You may find that it is cheaper to go that route. Look into calling Roche to see what they have to offer. How long is your course of radiation??

Randy
Dx 2006 IIA rectal cancer
6 wks rad/Xeloda
1st attempt transanal excision 11/06
11/17/06 XELOX 1 cycle
5 mths Xeloda only - blood clots 1/07
transanal excision 4/20/07 path-NO CANCER CELLS!
NED now and forever!
Perform random acts of kindness
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Re: Xeloda users

Postby jmarie » Sat Dec 04, 2010 2:55 pm

My copay was 210 at first, then my ins company switched to a mail order company for it and it went down to $190. I was surprised at how good the mail order service was. Xeloda was always overnighted and they always called to see if I needed my refill.

Now that I am thinking of it though, I think it should have put me above the yearly pharmecy out of pocket. I need to look and see where I am at. Last year my out of pocket was $1950 out of $2000. So close to free drugs!
DX Stage IV 11/25/08
mets liver lung, kras mutant
Baby 2yrs old! I am 32yrs
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Re: Xeloda users

Postby maxum2199 » Sat Dec 04, 2010 3:11 pm

Thank you all for the valuable information.My co-pay is a mail order price.What it is is what it is.Thank you all..........Randy :
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Re: Xeloda users

Postby Bob_Weiss » Sat Dec 04, 2010 3:17 pm

I received a monthly shipment of 84 pills (the large 500mg) size. My co-pay was $410. Using my chemo addled brain, I think this is about $5 per pill. Since my insurance paid 80%, I was satified.

Xeloda is costly, but everything in cancer treatment has been. Without insurance, I'd possibly wind up at my neighborhood shelter. So God bless EMPIRE Blue Cross.
Stage 3 R/C -1 node+ ( 7/09)
5 wks radiation, 2 wks chemo: 5FU (8-9/09)
Rectal surgery: tumor removal (11/09)
10 rounds Xeloda: 3000mg/daily 1 wk on/1 wk off (1/10-6/10)
Supplements: Aspirin, Calcium, Vit. D3
11/14: 5 yrs. since surgery--still NED
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Re: Xeloda users

Postby dianne052506 » Sat Dec 04, 2010 3:49 pm

My onc writes the prescription so that one refill has all the Xeloda I need for the month, so I pay one set of co-pays for 2 rounds of chemo. I save that way, but since I take 800 mg/twice daily, I am using both the 500 mg pills and the 150 mg pill, and have a separate co-pay for each strength. I think that's sort of bizarre, but can't help it.
Dianne
May 06 Stage IV CC: liver,ovarian mets
Oct 07 inoperable lung mets
Feb 08 - Apr'12 chemo
allergic to oxaliplatin, irinotecan
Aug '12-Feb'14 Genentech PD-L1/Avastin trial
Mar '14 -radiation to largest lung nodule
still recovering; looking at trials again
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Re: Xeloda users

Postby betsydoglover » Sat Dec 04, 2010 4:26 pm

I have a 3-tier system also. In 2005, Xeloda was in the non-preferred tier and I paid $35 for a 3 week cycle (14 days of pills). In 2009 when I took it again, it had become a tier 2 drug and I paid $25 per 3 week cycle.
Betsy
diag. Stage IV, 5/05, liver met
lap sigmoid colectomy, 6/05
6 cycles Xeloda/oxaliplatin/Avastin (NED after 2)
11/08 9x13mm right lower lobe lung nodule; removed via VATS 4/09
6 cycles Xeloda + Avastin,
NED (PET every 3 mo)
Avastin only 10/09-5/11
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Re: Xeloda users

Postby Mailman » Sat Dec 04, 2010 5:20 pm

I am 21 treatments into my 25 chemo/radiation treatments and my Xeloda 500mg is $150 per 30 day supply. Doesn't matter how many are in that 30 day supply. And it's been overnighted both times. I have no choice but to purchase it from my mail order "specialty pharmacy" but I've been satisfied with the service so I have no complaints.
Dx 10/10 RC, Age 62
T3N0M0 Adenocarcinoma
Neoadjuvant Chemoradiation
Xeloda
TEM 3/23/2011
Xeloda 6mos
NED
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