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chemo cost

tgif i guess

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please remove if threads like this are not allowed

my question is about the cost of alimta.  my oncologist said my private insurer will not cover the cost of the drug.  it was covered for months but the reimbursement rate changed.  as i understand it, private insurance cannot pay less than medicare but are allowed to pay more.  

there seems to be a 'bio similar' drug, pemfexy.

looking at the coding for alimta, the average sales price:

ASP Drug pricing - J9305

Jul 1, 2023 - Sep 30, 2023                     10 MG           7.933

April 1, 2023 - June 30, 2023                 10 MG           17.141

January 1, 2023 - March 31, 2023          10 MG           27.681

October 1, 2022 - December 31, 2022    10 MG          47.747

Jul 1, 2022 - Sep 30, 2022                       10 MG          78.393

from july of 2022 to july of 2023 the reimbursement for medicare dropped.  which means private insurers can drop theirs.

pemfexy is currently at 64.476

after a delay in treatment, the office manager found a source for alimta but not sure how long they will offer it at that price

evidently it is illegal for me to pay the difference in price - but i assume i can pay the full price

anyone else having problems getting alimta?


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Oh my, I hope others are not having difficulty getting Alimta! Paying for it (and for all new medications) is always another matter. I believe your information about Medicare pricing is correct. Medicare is insurance. It is a very large program and is often a market maker price-wise but you are correct. There is no requirement for private insurance plans to adopt Medicare pricing. 

I'm glad your clinic found another affordable source.

Stay the course.


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