The True Cost of Herceptin

If you’ve been reading this blog recently, you know that I am very concerned about the high cost of cancer drugs. I get two of the most expensive, Herceptin and Avastin, every three weeks, and as a result of the cost of these drugs I am going to max out my health insurance coverage before the end of the year.

This morning, I had a very cordial conversation with a spokeswoman for the company that makes both drugs, San Francisco-based Genentech Inc., (Ge-NEN-tech, please. It turns out I’ve been pronouncing the name wrong all these years. Who knew?).

I’ve been bugged by press reports, in USA Today and elsewhere, that say Herceptin, a targeted antibody used to treat breast cancer, costs $3,000 a month.

That’s not what I pay. (Or not what my insurance company pays, anyway.)

Herceptin costs my insurance company $78,812 a year.

Why? The short answer is, it’s all in the markup, both by distributors who sell to cancer centers, and then a further markup by the cancer centers themselves.

How about some legislation to limit how much cancer centers and distributors can mark up these drugs? I don’t think Genentech is the bad guy here.

What’s the Deal?
For those of you who like math, follow on.

The Genentech spokeswoman, who didn’t want her name used because she is going out of town for two weeks and won’t be available to answer questions from others, told me that the company’s price for a 440 mg. vial of Herceptin is $2,400, or about $3,100 a month.

That’s the price that is usually quoted in the press, but no cancer patient actually pays that, so it’s misleading. It is, essentially, the wholesale price.

And let’s ignore the monthly figure, because it’s confusing. Some women get Herceptin once every three weeks, some get it every week, depending on what their doctors think is best.

I get 411 mg. of Herceptin once every three weeks. So that’s a little less than one 440 mg. vial.

But my dose doesn’t cost 93 percent of $2,400, which would be $2,232.

Until recently, I got my care at the Seattle Cancer Care Alliance, which charged me $6,254.95 for one dose of Herceptin. In November, I began going to the Swedish Cancer Institute for my care, and Swedish charges me $9,599.10 for one dose of the same drug.

My insurance company, WSHIP doesn’t pay that amount, but it still pays $4,635-and-change for each dose of Herceptin.

More math: Fifty-two weeks in a year. One dose every three weeks means 17 doses a year, and the total is $78,812 for one year’s worth of this life-saving drug.

So back up to the price per dose--who gets the $2,403 that is the difference between what Genentech charges for that one dose and what my insurance company pays?

This more than 50 percent markup goes to the distributor and the cancer center. I don’t know yet what the split is, but let’s assume it’s 50/50.

My cancer center also charges me about $2,000 to deliver my drugs each time I go in for this out-patient treatment. (My bill from Swedish shows nine separate line items labeled simply “hospital” and two more labeled “treatment room.” SCCA charged about the same.)

Then there’s the mark up on the other two drugs I receive, and the cancer center is being paid something like $5,000 for its services each time I receive treatment.

Seems a bit excessive to me.

@ Jeanne Sather 2007.

Comments

[Dee]

Jeanne,
I've just found this site and I love it. My doctor is strongly suggesting Herceptin and I was looking for costs. Thank you for a site that offers some humor, sensitivity and perspective.

Dee

[Bish]

Hi Jeanne,

I am from Kolkata,India, and my mother underwent a mastectomy in Mar-2005 followed by Chemo & Radio Therapy.

Just stumbled upon your blog and thought of that if you could share all the best-pratices & management ( especially post treatment) guidelines so that I can benefit from them.

You can reply me back to my email id.

~Thanks in Anticipation

[Bish]

Hi Jeane,

Sorry I forgot to mention my email : ranjita.joone@yahoo.co.in

~Thanks

[jeanne]

Hi Bish--sorry, but this is not something that I am qualified to do. Sorry. Jeanne

[baharazwar]

Hi Jeane, I am an oncologist surgeon in Indonesia. I tell my patient about this wander drug but I don't suggest them to take it.

[Chan]

What was your out of pocket expense for each dosage of herceptin - was it 2K, not sure if I got it right and is it worth it. Any other alternatives? Thanks and appreciate your posting.

[Lana]

Hope you are well. Hope to receive your reply soon.
My doctor just recommended Herceptin for me. But she said treatment will be 2 years. I'm wondering if it's necessary to have 2 years. In most online articles, it said 1 year is enough.
I'm looking for advices and/or treatment experience.

[Deep Mathur]

Hi!My name is deep and I am from india. My aunt is suffering from breast cancer which is in advance 3b stage.Doctor has advised to take Herceptin dosage for a year. Please suggest what is the approximate expenditure for this and what is the chances of cure in it.

[Les Easley]

My wife has had the toxic
substances Cytoxan and
Taxotere for four months
then was started on Herceptin last November to
receive this "wonder drug"
every three weeks for a year. The cost to Medicare
and Champ VA do pay about
80 % but at $6,700.00 per
infusuin that ammounts to
#47,000.00 plus the cost of
the actual infusions by RN's in the treatment room
which has been about $2,000.00 per visit, ot another $39,000.00. Is it any wonder that Medicare is
being bancrupted? One can
not get the actual cost of the Herceptin to the Cancer
Clinic's Oncologist. My wife has also had two bouts of Pneumonia with one
resulting in hospitalization which cost
$27,000.00. She has almost
constant bronchitis. This
makes me want to contact a
good Tort Lawyer since she
almost died of congestive
heart failure whule being
given too much IV fluids
with the antibiotics while
in the hospital. When will
we as consumers demand more
sensible use of these drugs
and fight for more reasonable prices?

[Les Easley]

I did not include the cost
of the chemotherapy which
was about $70,000.00 for the four months it was the
trearment of choice of theOncologist at another cost of about $60,000.00.
One can do the math but the
costs are more than $200.000.00. We are grateful for Medicare but
can understand why some in
politics would rather see
us "oldie's" just be given a hemlock dose and told to go home and enjoy your last days since our governments money would be better spent on those with
more time left as those under 40. Now I have been reading Dr Cutler's natural cures for cancer
and how doctors going for these are being chastized.

[donna casey]

Les, My mom is waiting bone biopsy results and if she'll take herceptin. she has medicaire which you said covers most of the cost for your wife. what is your out of pocket per treatment. thank you

[Arvind Patro]

just on 2nd Nov my moms right breast has been removed due to HER-2 Neu ONCOPROTIN(DAKO)
Now my oncologist suggest to take HERCIPTIN for 8-9 cycles.but the price of the same $2300 in india.

i want the best suggetion

1. is the price is suggestable
2. is the perfect medicare for this situation for improvement of patient.

[Armaan]

My mom has been put on this wonder drug for a year.According to the Doctors it is mandatory to be given for one year.But i have heard theory's of how only 9 weeks it enough for the same results and that this is just a propaganda to make more money.Now we are curious and wandering whom to believe.Can you shed any light on this?
Thank you.

[afshinfarane]

please guide me about exact cost of herceptin . i really need to know that .

[kreddy]

I am an oncologist here in USA. the procurement cost of herceptin from distributor is $2800 per vial.
There is a trial called FINHER (NEJM; 354; 809: 2006) which showed 9 wk Rx has comparable results to 1 yr Rx. The study is somewhat flawed and oncologists have not accepted that, but if there is a bigger trial comparing 9 weeks to 1 year is done in the future, and shows equal benefit, this will perhaps cut down costs.