For two and a-half years I have been blessed to be able to receive Benlysta infusions for my lupus. Every month, I went to a hospital all the way across town. My employer-funded health insurance required that the infusions to be given in a hospital, and not at my previous rheumatologist’s office. After recently changing doctors (leaving my out-of-network rheumatologist to start seeing a doctor who participates in my HMO plan,) out-of-pocket office visit costs dropped by $90 each visit.
The rest of the story? Someone besides me is saving money, my self-insured employer is saving dramatically more!
My local government self-funded health insurance plan has a major insurance company serving as their TPA. Now, they are paying for my Benlysta infusions at my new doctor’s office, instead of requiring me to do it at the hospital. I never understood why they insisted I get them where it cost so much more.
Yesterday was my second visit with my new doctor, when she told me I was “already famous” in the Benlysta world. I looked at her quizzically and asked, “really?”
She explained that she called the Benlysta “people” to coördinate my infusions, and once she started telling them about her new patient, they already knew all about me. When they heard from her that I had been getting infusions at a hospital before coming to her, they knew immediately who I was! They asked who my former doctor was, and sure enough, they confirmed it was little old me they were all talking about.
I have to say, this realization made me feel a bit weird. I guess they all had a conversation discussing the novelty of my situation. If I remember her story correctly, they told her I was the only patient they knew who had to get Benlysta infusions at a hospital. Then, I filled her in about how much better the in-office infusions were for me and my employer.
As we discussed costs, it astounded her that the hospital had charged three times the normal price for the infusions. Now, instead of the $13,000 the hospital charged for my January infusion, the total cost to my insurance company for February’s in-office infusion was about $3,500! Even at this lower (normal) price, Benlysta is expensive, just like other biologic drugs. The astounding extra my insurance paid over the 2.5 years I’ve got Benlysta could have totaled as much as $250,000 to $285,000! All I can say is, “wow.”
Although there were no copays at the hospital, now there are office visit copays of $35 for each infusion. I can handle that! Since I no longer have to spend money on gas to drive clear across town twelve times each year, or to pay for parking at the hospital, everything should pretty much be a wash in my out-of-pocket expenses. Eliminating parking fees for a year will pay for 4 of the infusion copays!
The real bonus is to my self-insured employer. The lower infusion costs will save an annual amount that could pay for at least two standard clerical co-worker salaries. As a serious public servant and steward of taxpayer money, that pleases me greatly. I guess the number-crunching bean-counter part of me that manages my department budget is doing back flips over this realization.
In a post-recession economy, where you get Benlysta could really make a big difference!