Discussions that mention zometa

Cancer: Prostate board


[QUOTE=richarda123;3411363]...
My questions are:
1. have ins. with 1M cap: will this last?
2. does one still have to wait for SS benefits? thought I read if PC treatment fails you can sign up earlier??
3. any info on 401K and when you can go that route w/o penalty with cancer diagnosis?

Again; just stumbling around here and hope I don't appear too foolish. Daughter just graduated from college and things were good but I just don't want to watch everything $$$ disappear for the family.

Hi again Richard,

I think many of us had the $$$ concerns that you have at the beginning. You've had some fine responses from daff and able5 already, including that detailed account from able5, but this is probably a case where it's good to hear multiple experiences. This is not a disease where you rack up a $100,000 operation followed by a long and very expensive stay in intensive care, at least not typically. The usual major therapy options range roughly in cost from $5,000 to $50,000, I would estimate, including most of the costs, but ongoing therapy like mine, where the disease is not considered curable, can lead to higher costs, as can having to have more than one therapy, such as surgery plus radiation. Costs of therapies vary quite a bit. There is even great variation within therapy classes, such as conventional radical prostatectomy versus Da Vinci robotic prostatectomy, and TOMO radiation therapy versus Intensity Modulated Radiation Therapy (IMRT).

Have you considered Medicare yet? That would probably take some of the load off your insurance. I'm months away from eligibility so I am not familiar with it.

There are some aspects of the disease that can be expensive, but a $1M cap gives you some room to roam. I'll outline costs for my own therapy and then mention some of the high cost items I know about. It's no picnic having to pay out costs for medical treatment, but my insurance has been a wonderful shield for the financial well-being of my family.


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I have been on intermittent triple hormonal blockade therapy with maintenance drugs when I'm off therapy, having no other treatment - no surgery, no radiation, no cryo, no etc. Basically when "on therapy" I get a Lupron shot every three to four months, take one Casodex pill daily, take two finasteride (generic) pills daily, and take one Boniva caplet monthly. My Casodex pills cost me $35 for a 90 day supply whether I take 1 to 3 per day (1 for me always), but they are expensive without insurance. Finasteride is a $10 copay for 90 days, and Boniva is $35 for 90 days. I'm including simvastatin because I take a statin mainly to help prevent lethal prostate cancer, though I get a double benefit for cholesterol. I'm including Celebrex because I was on that for a while. The dose I was on was probably quite safe, but it was not high enough to help me. Following able5's lead, here's some data about the insurer's costs for my program:

Item..............Quantity.......Insurer's Cost....My Co-Pay.....Total Cost..[email protected]/day

Lupron..........4 months........$5,408..............$192...........$5,500.00

Casodex............90.............$959.84..............$35...........$994.84....$11.05

Finasteride.......180.............$214.14..............$10...........$224.14....$ 1.25

Boniva................3.............$162.29..............$35...........$197.29....$65.76

Simvastatin.......90..............$167.12..............$10...........$177.12....$ 1.97 20 mg

Celebrex...........90..............$168.05..............$35...........$203.05.....$2.26
200 mg

It's now been a little over eight years since I was diagnosed. I've been on Lupron for two sessions totalling 50 months. I've been on Casodex for about 48 months, and on finasteride for 41 months overlapping Lupron and Casodex and another 46 months up to the eight year point, totalling 87 months for finasteride (initially was Proscar at double the wholesale cost before it went generic). I was on Fosamax or Boniva (both bisphosphonates to protect bone density) for 87 months, and I should have been on a bisphosphonate for all eight years. I was also on Thalomid (thalidomide) 50 mg for six months, enabling me to avoid six months of Lupron and Casodex costs, but I don't have those cost figures and such use of Thalomid is still a rare tactic. I won't count the Celebrex as using Celebrex in support is not yet common either.

Ideally, I would have been on Lupron, Casodex, finasteride, and a bisphosphonate for 50 months, plus an additional 46 months for a total of 96 months of finasteride and a bisphosphonate during off-therapy maintenance time. I wish I had been on simvastatin for all 96 months too, as the amount of protection you get from lethal prostate cancer is much higher by the three year point, so I'll use 96 months for simvastatin below. The costs for eight years would roughly work out to be:

Drug Costs Over Eight Years

Lupron ($5,500/4=$1,375 per month X 50 months)...........$68,750

Casodex ($994.84/3=$331.61 per month X 50 months)......$16,581

Finasteride ($224.14/3=$74.71 per month X 96 months).....$ 7,172

Boniva ($197.29/3=$65.76 per month X 96 months)..........$ 6,313

Simvastatin ($117.12/3=$39.04 per month X 96 months)...$ 3,748

..............................................................TOTAL.. .$102,564

Costs to diagnose and stage the disease would be in addition to this total, as would doctor consultations/exams and tests. My folder is probably well over an inch thick, so those costs would add up. For me diagnosis and staging involved a biopsy, a bone scan, a CT scan, and a ProstaScint Scan, the latter costing $3,400 for the insurer. (I was billed a $12 co-pay, but later a hospital audit determined that was improper, and I got a $12 refund. Not bad for a $3,400 scan! :)) Now an improved version is available that costs about $5,000 for the insurer. The most expensive recurring test/scan I have is a yearly DEXA scan. It's free to me, but I think it runs several hundred dollars. For someone with a challenging case, you will probably be seeing a doctor every two to four months. You will also probably get regular blood tests, a PSA test, and perhaps some other tests depending on your therapy(ies) such as a 25-hydroxy vitamin D blood test, a PSA blood test, a testosterone test, and a DHT blood test. (That's base on my frequent tests.)

When you add it all up, its not small change. But it is also far under even $200,000, so your cap allows you room for other major diseases. Aren't you happy? LOL ;) Of course, hopefully you will live far longer than eight years, but you can see that just hormonal blockade would not bust the budget. Of course, if you have surgery first, then radiation, and then perhaps continuous blockade, that would add a lot more cost. But it still would fall far short of $1,000,000, even allowing for extra years. Also, some of our key medications will run out their thirteen year patent exemptions, some fairly soon, and that will bring costs down as generics become available.

On the other hand, some emerging therapies, especially immune system therapies, can really jack up cost. For instance, the prostate cancer drug Provenge, which will come up for FDA approval again this year, is estimated to cost about $50,000 to $65,000 for all three doses or an additional booster. The drug Zometa is by far the most effective bisphosphonate drug for preserving bone density and helping prevent or even reverse bone metastases, but my recollection form talking to patients on that drug is that it costs about $900 per dose, and for patients trying to reverse bone mets, the dosing can be as frequent as every three weeks. The drug Revlimid (lenalidomide) is an improved version of thalidomide - a better side effect profile, a bit safer, and more effective. But it is very expensive at a discounted cost of $16,999 for a 90 day supply. Considering what I would need it for - extending my off-therapy period, and the safety, acceptable side effect profile, acceptable effectiveness and far lower cost, I will use thalidomide again instead. I would not feel right sticking my insurer with that huge cost even if they would accept it, which I very much doubt.

Leukine is another promising but expensive drug, one that Dr. Myers describes and illustrates with patient examples in his book "Beating Prostate Cancer -- Hormone Therapy & Diet." That's a drug that many of us with challenging cases may someday find useful in our programs. I don't have a cost estimate.

I hope this helps.

Jim