Stelara results & $$$

** Originally posted by PJLeary **

Hi All,

I just went through the entire approval process for Stelara with my insurance company and my fab Dr M. The cost to my insurance company was $21,000.00.

That means that the first year of treatment is +$100,000.00

Subsequent years cost $80,000.00

Centocor has a very nice patient assistance program that waives all co-payments for patients with any type of insurance for the first three doses. That gets the patient through the loading dose without any out of pocket cost. They also have a very generous assistance program for folks who have no insurance. There are various assistance programs available after that. Information and applications can be found here:

http://www.stelarainfo.com/stelarainfo/patient-support.html#costsupport

What I can report is that I was photographed ( at my request ) by my fab Doc M's staff before I began treatment last Tuesday afternoon. I was very easily 80%, a situation exacerbated by a current strep infection that had been diagnosed the Friday before. My fab Doc M had already started me on a course of antibiotics for the infection days before I got my first dose of Stelara.

I am continuing the course of antibiotics.

The really good news is that as we have learned from folks who posted their experiences during the trials, I can confirm it does work that quickly. On Tuesday, I had severe palmar & plantar pustuloisis, one cheek on my face covered with plaque , and 80% of my body involved with psoriasis skin disease.

Today is Friday. I began to notice serious changes in all of my psoriasis plaques 48 hours after the first injection. At 72 hours, most of my plaques are completely flat and thinned out, with the exceptions being at my extremeties.

In my usual healing pattern, my body is clearing from the torso out. That means that my face is clearing, and my hands are as well. My feet will take longer.

I am amazed at how quickly this medication is working. While the side effects of rapid clearing are not pleasant, they are easily managed with comfort medications like attarax & tramadol.

While I am so relieved to finally have treatment that is working, I am equally dismayed when considering the few patients who will be able to actually get it that really need it. I have been anxiously waiting for this to be FDA approved for 18 months, and I know that there are many others who have also come to the end of the biologic options.

Anyone who has any suggestions about how patient assistance programs can be improved, or any other related suggestions, please post here or send me an email or both.

Right now we all need to support each other as much as we can.

Regards,

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15 replies. Join the discussion

** Originally posted by Wes_H **

$21,000 a year is on par with the other biologics. I also believe there is some discounting to the insurers along with copay assistance for prescribees.
I am also unsure about the math given for cost.

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** Originally posted by LikeNoOtha **

When I first talked to Diplomat Specialty Pharmacy they quoted the injections at 11,000 a piece I have then spoken to the actual manufacturer and they quoted it at 5,400 a piece....its all very confusing. I was referred to the Janssen Ortho Patient Assistance Foundation through Johnson and Johnson.

The number- 800-652-6227 M-F 9am-6pm

Website- http://www.access2wellness.com/a2w/home-resources-contacts.html
(Click the application link)

Fax number to fax app- 222-586-5168


Basic Requirements to qualify are: No Health insurance and a qualifying income.


They are the manufacturers assistance program all others I contacted told me to go with them.


Good luck to all its always worth the shot!

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** Originally posted by mstaylor **

Wow, lots of different cost numbers flying around. Yep it's very confusing.

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** Originally posted by SuzanneT **

Jamie,

Basic Requirements to qualify are: No Health insurance and a qualifying income.

Just curious, did they tell you what 'a qualifying income' means?

Right now I have insurance, but I don't know how long it will last.

Sue

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** Originally posted by pattyr **

So...does anyone know the "real" cost for this drug. Unbelievable that this so called replacement for Raptiva cost so much. When I was using Raptiva, my co-pay thru mail order insurance was $40 per injection.

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** Originally posted by pattyr **

When I was taking Raptiva, cost quoted from mfr was $4,000 per injection, and I only paid $40 with insurance. Makes you wonder if the cost of Stelara is $5M per injection, if the copay would be $50.

Patty

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** Originally posted by oscarinfw **

This is just an indication of virtually zero cost control in the health care industry. The pharmaceuticals seemingly can establish any "MSRP" they want and the health care insurers can "negotiate" a lower cost (which the consumer will never find out about). with said pharmaceutical and I bet both wind up making massive profits while writing off "losses" for tax purposes. If the cost of "production" of these drugs were really that high, the pharmaceuticals would not be so quick to provide drugs for "compassionate use" or "hardship" cases.

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** Originally posted by MARCIA70 **

i have anthem insurance and use rx specialty pharmacy for my meds . i was told that 1 45mg shot was $ 4,750 . i live in virginia . i am a warehouse manager..........i think i'm in the wrong business !!

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** Originally posted by PJLeary **

Hi All,

It is true that my insurance company was billed $21K for the first dose,. I am not sure how other companies are covering this. I am sure that my cost if I have a full dose this year will be +$100K.

Then there has been no discussion of serious complications, which I have experienced and placed me in the hospital this past Sunday. All I can say about that for helpful information is to be sure you are completely clear of any infections when beginning this treatment.

I experienced very serious complications that placed me back in the IU this past Sunday for most of the day.

What I can say to anyone considering this course of treatment is this:

1. Be very well informed about what you are planning.

2. Have at least two people available to talk for you with complete information and access to your most important health care providers ( hopefully they are Dr."s

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** Originally posted by Wes_H **

I think you are wrong about the cost. Sorry to hear about the complications.

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** Originally posted by mstaylor **

Sorry to hear you are having problems PJ,
Sounds to me like the pharmacy handling Stelara for your area is ripping your insurance Co off, that cost is just to outrageous.
The warning not to start Stelara if you presently have TB or an active infection or have issues with recurring infection are clearly printed out but I suppose it's possible to have one and not know it.
It's hard to imagine that your Dr. allowed you to start treatment given you had a strep infection.
Again I'm sorry. Please keep us posted and feel better soon.

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** Originally posted by PJLeary **

Hi All,

I am pleased to report that I am feeling much better, the strep infection has been effectively treated.

In response to mstaylor's observation that it might not have been the best choice for my Dr to begin this medication so early into treating the strep infection, I will offer this further information. I'd been barely holding off a complete Erythrodermic event in the months leading up to this. In my past, my fab Doc M has never discontinued any biologic or systemic treatment that was working regardless of any infections that might occur. His approach is that allowing my disease to become seriously inflamed is not in my best health interest. Even if I might have some negative side effects including issues with infections, the treatment is still doing a greater good. So, Doc M treats these side issues as they arise. I need to say that I agree with his approach.

I know that there has been much discussion concerning the cost of Stelara. I can honestly report that the costs I have noted above are accurate within a 1K variance.

I was actually asked by a pharmacy specialist employed by my insurance company ( and associated with Caremark ) if this medication was actually worth the cost. The only answer that came into my mind was to ask her what price she would put on the ability to walk. As many of you know, I spent months in a wheelchair this past year, including the time we spent at CHD '09.

I hope that folks reading this who have exhausted previous treatments might take heart from the possibility that there is a new medication that could help to control this disease. While I believe there is great hope for the efficacy of this new drug, I know that since I began treatment most of my body's plaque is seriously thinned out, but the p on my face now covers the entire right side, and is morphing over to the left. That so sucks.

Hopefully we can all continue to learn from each other as we try to minimize the effect on our general well being and happiness.

Regards,

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** Originally posted by Wes_H **

In scouring the internet it appears that the British health system pays $15,256.18 for one years dosing of stelara per patient whether the 45mg or 90mg dosing schedule. If J&J is actually charging 100k a year for it's American customers then that is truly price gouging in the first degree.

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** Originally posted by mstaylor **

My first shot was 4,700 discounted from 5,800 for some reason . I will see as time goes on what the charge is as to whether I will always get the discounted price or if it will go to 5,800 as originally quoted to me by the pharmacy. I don't think it's J&J that's doing the gouging I believe it's the pharmacies handling it for each area that are adding the big chunk of money for handling and distributing the product.

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** Originally posted by mstaylor **

A pharmacy that distributes these kinds of drugs should have some sort of ceiling on what they can charge for the distribution of the product. Looks like there is a huge difference as is the case with PJ LEARY and the outlandish amount being charged to her Ins.

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