Price of Stelara! $$$$$

** Originally posted by Sravaka **

OMG . . . I just received my insurance EOB summary from my first Stelara injection and I can't believe my eyes. I know the wholesale cost of Stelara is about $5,500 my sister-in-law works in a pharmacy and looked it up for me. But when I got my insurance statement it said they reimbursed my dermatologist over $13,000 for the shot!!!! All I can say is that's a pretty nice profit for my doc for an injection that took a couple of minutes to administer. Holy cow!!! I am so thankful that it didn't cost me anything out of pocket but I guess I have turned into a "high maintenance" kinda guy. LOL

Sravaka

Report post

26 replies. Join the discussion

** Originally posted by Wes_H **

Did you receive the 45mg or 90mg dose. Your doctor shuld have also received the second loading dose at the time. So either 2 or 4 45mg vials divided into 13k is the cost...still pretty pricey by any measure.

Report post

** Originally posted by Sravaka **

You know I didn't even ask about the dosage, the vial looked pretty small though, way smaller than a Remicade vial. I don't think my doc got more than one dose since my insurance company told me to call their specialty pharmacy a couple days before my next appointment for the refill to be sent. We will see what the next EOB looks like.

Report post

** Originally posted by jrw21780 **

Your doc is not making money off the Stelara. A specialty pharmacy gets a cut, and of course Stelara (JnJ) is making money. Once you look at what they did to get the drug to market, it's easy to see why they charge what they do. the 45mg shot is roughly 25K pr year. I haven't seen if the 90 is 2X the price. Humira/Enbrel are roughly 18-19K pr year.

I'd refrain from beating your doc up on med costs...they don't make anything off p patients.

Regards

Report post

** Originally posted by Sravaka **

You have severely misinterpreted my remarks. I was not "beating up" on anyone. I was just amazed at the difference in cost vs what my EOB said. Rather than telling me what or what not to say, maybe you could tell us something constructive like where the $7,000 went hmmmmm? And you are wrong about the price of Humira. I was on a double dose, thats one shot a week, and it was $3000/shot for a total of $12k/month. Of course the cost on it was about half that, which is weird because that seems to be the same level of markup that the Stelara has . . . what a coincidence . . . oh and BTW, my rheumi didn't make anything on my Remicade infusions either . . . LOL

Report post

** Originally posted by Connie1313 **

My doctor called today and wants me to start Starla and I had no idea how much it cost. Thanks for the info. Enbrel was $2300.00 a monthand I thought that was bad. I will go bankrupt the first month.

Report post

** Originally posted by Sravaka **

Connie1313, please, before you make any treatment decisions, look into the price yourself and, if its not too much trouble please report back here what you find. I would like some people to get some independent confirmation of the facts that I have found in my experience.

Report post

** Originally posted by jrw21780 **

You have severely misinterpreted my remarks. I was not "beating up" on anyone. I was just amazed at the difference in cost vs what my EOB said. Rather than telling me what or what not to say, maybe you could tell us something constructive like where the $7,000 went hmmmmm? And you are wrong about the price of Humira. I was on a double dose, thats one shot a week, and it was $3000/shot for a total of $12k/month. Of course the cost on it was about half that, which is weird because that seems to be the same level of markup that the Stelara has . . . what a coincidence . . . oh and BTW, my rheumi didn't make anything on my Remicade infusions either . . . LOL

Many of us would like to lash out. I'm particularly hard on the docs, but they can handle it. If you wish to lash out at me, and that helps, then wail away!!! P sucks, med costs are ridiculous, but those costs are actually the reason for the drugs existence. Without an insurance funded market for 20+K pr year pr patient we'd know less, and have less treatments than we do.

I actually wrote both my senators once I determined drug cost ect and beat them up as well. I'm sure they can take it too.

Regards

Report post

** Originally posted by Sravaka **

jrw21780: BTW, my insurance company, Providence, makes me buy my biologics from their specialty pharmacy. It seems unlikely that they would charge "themselves" that much. For you to say that doctors don't make money off their patents is absurd. My tech that gave me my infusions at my rheumi's office told me the difference between the cost of Remicade and what the doctor charged and said that was what they made on the drug so please enlighten me as to why a dermatologist would be any different?

Report post

** Originally posted by Sravaka **

jrw21780: I have been on biologics for many years and understand who I owe my quality of life to and what it takes to bring this stuff to market. I am not lashing out at you, only pointing out the errors in your remarks.

Report post

** Originally posted by jrw21780 **

Examine your insurance statements. You will see that your doc only gets a co-pay and office visit for Stelara injection (100-200 dollars). Your drug plan will pay out to the specialty pharmacy that should be a part of their plan. The actual drug cost depends on the purchasing power of your insurance. Pharmacy gets a cut, and the rest goes to JNJ.

Docs are not pharmacies. Drugs come from pharmacies.

Report post

** Originally posted by Sravaka **

I am scanning my EOB to post right now. It says nothing like anything that you are saying.

Report post

** Originally posted by Sravaka **

ok attached here is the scan of my EOB. As you can see it says nothing about office visits or copays or anything else. Just the injection. For some reason though, I just noticed that they actually disallowed the claim because they said my doc used the wrong ID# but I checked it and it was right so I guess I am calling them tomorrow . . . sigh.

Report post

** Originally posted by jrw21780 **

http://www.fda.gov/ohrms/dockets/ac/08/briefing/2008-4361b1-02-CENTOCOR.pdf

For what Centocor went through to get fast tracked.

http://www.talkpsoriasis.org/showpost.php?p=409158&postcount=18

Particularly part 4 and 5. Describes the docs will not be buying the drug, patients will through specialty pharmacies. There's also a "rant" by Dr. Theirs on page 430 that is relevant to this conversation.

Guess I'm now a real poster being accused of having ulterior motives.

Report post

** Originally posted by jrw21780 **

13K is high for the 45mg shot. I have no pricing info through medco for the 90mg shot...it probably is 2X. See this thread for my price break down...

http://talkpsoriasis.org/showthread.php?t=39721&page=6

Report post

** Originally posted by Sravaka **

Both of your links are 404 NOT FOUND lol!!! But I think I see the distinction you are making. It is JNJ not my doc that is making the spread between the cost and what is billed yes? I beg your pardon if I misunderstood but my comments were really just related to my reaction to the cost. In reality I do not care who makes the $.

Report post

** Originally posted by Sravaka **

I noticed in your price breakdown, in link #3, that you are using Medco, which is a Medicare plan for your pricing. I wonder, since we all know Medicare reimburses doctors less than anyone else, if maybe they pay less than Providence for the meds . . .

Report post

** Originally posted by jrw21780 **

I'm not medicare, and the links should work now. I'm 29, which should be obvious ;-)

Report post

** Originally posted by Sravaka **

Sorry my mistake but it made sense to me since I googled medco, and that is what came up, and if you are disabled and on SSDI, like me, then you qualify for medicare. I only take part A since it is free and I am lucky enough to have private insurance through my wife's employer.

Report post

** Originally posted by jrw21780 **

I'm so sorry to hear you are disabled!!! For me understanding how everything works provides a little bit of sanity. Stelara is an awesome drug...I'm into my 3rd week, and it's fixing me. The links I provided are better than network TV IMO. I'm kind of a science nerd though, and fully understand a lot of people not having patience or inclination for it.

Report post

** Originally posted by Sravaka **

well I have 2 rheumis at this point with very different mindsets. My local one, who has been with me 6 years since this nightmare began, is relatively uninformed about Stelara and I have printed off articles from links off this forum and given them to him. He seems very interested though. My other rheumi is up at OHSU. He is Dr. Atul Deodhar and he is actually one of the leading physicians participating in the clinical trials for this drug so he has been telling me about it for the last 2 years and I have been waiting. The ironic part is that I am getting it through my dermi since, as you know, the FDA has only approved for P at this point. Centocor is just now gearing up for stage 3 clinical trials for PA here in the US, they should be done in late 2011 or early 2012 I think.

Report post

This discussion is closed to replies. We close all discussions after 90 days.

If there's something you'd like to discuss, click below to start a new discussion.

Things you can do

Support the National Psoriasis Foundation

Help the National Psoriasis Foundation reach its goals and support people like yourself by making a donation today.

Donate to the National Psoriasis Foundation

Discussion topics

Additional resources

Community leaders