Hey Joe? You there?

Read this post from sheena http://neurotalk.psychcentral.com/sh...ysabri&page=36

then look for her latest posts. You can search on her posts by clicking under her pic on the left side of her posts and then click on "find more posts by sheena"

She went through some stuff too, but it all turned out ok. You can ask her too, cause she is still here and still on Tysabri!

Me too Vic!

I have Anthem BCBS of Maine. I am under an OLD plan where I have Major Medical and basic insurance, you know, the OLD insurance. Everything associated with my infusion costs is picked up by my major medical.

As I posted the other day, the cost of the drug being charged by the infusion center FAR outweighs what the infusion center charges for the actual infusion. I'm scrolling back here in the Tysabri forum to find out what the last increase in Tysabri cost was. If I have to hand carry my own Tysabri in I will, just to cut the infusion center's rip off.

I haven't heard from the specialist at BCBS after my talk with her the other day, but she is looking into what they are charging and how much it will cost by getting it through the ins. co. specialty pharm as opposed to the infusion center's supplier.

I forgot to tell you that the refund I am expecting is directly related to the "balance billing" thing you posted. They are going back to 1992 and they are going to refund me all the money I paid to any provider over what they paid after my deductible.

She said they would take it directly from the providers and refund it to me and deal with them on the overcharging. She said it was due to an error in how my plan was listed and that they were charging me as if every provider was out of network provider instead of a network provider, even though I don't have a network ( if they accept BCBS they are in network!)

I should be seeing a good chunk of change from this one!!:) I told her I want an itemized list of every overcharge to compare to my own records.

I am going to go to bat here for the Tysabri users out there. The charges some of you are being charged for infusion itself are outrageous! I'll start making some noise and see what comes of it. If I need some voices I will let you all know!!

"Elan to decide on $300m new plant as revenue rises

By John Mulligan

Friday October 24 2008

Irish pharmaceutical firm Elan will make a decision before Christmas on the proposed location in Dublin for a $300m manufacturing plant, according to chief executive Kelly Martin.

Speaking yesterday as the company announced a 53pc year-on-year rise in revenue during the third quarter to $270.1m, Mr Martin confirmed that the planned sale of the company's drug delivery unit has been postponed "for the foreseeable future".

Elan's shares tumbled more than 9pc in Dublin yesterday to close at €5.64.

It had been expected that the drug technology unit could attract a purchase price of up to $1.4bn.

Chief financial officer Shane Cooke said there had been "considerable interest" in the unit, but that a decision had been made to pull the sale. He said structures would be put in place to fuel growth at the drug delivery division.

Private Equity

Private equity giants including Texas Pacific, Bain Capital and Warburg Pincus had all expressed an interest in the business. Kohlberg Kravis Roberts and Cinven had already pulled out of the bidding process.

Mr Martin added that the planned sale "wasn't a balance sheet reason; it was a strategic reason" when asked how the postponement might affect its ability to repay $1.1bn of debt that matures in November 2011.

He added that it would be premature to say what options the company would explore in relation to the debt.

Elan said that its adjusted earnings before interest, tax, depreciation and amortisation were now close to break-even, and that the break-even position should be achieved by year-end.

It posted a net loss of $84m for the period, down from $87m a year ago, beating estimates.

Patient enrolment for use of Elan's Tysabri multiple sclerosis treatment declined after two new cases of the life-threatening brain disease PML were discovered during the summer. One of those patients has almost recovered, while the other was "not in good shape", according to Mr Martin.

CFO Shane Cooke added that extrapolating patient enrolments since the summer, Elan would have 60,000 people using the drug by the end of 2010. That's below the 100,000 target the company hopes to reach. For every 10,000 patients that sign up to use Tysabri, Elan generates an extra $100m in annual profits.

Moderation

"There was a moderation in subscribing habits," conceded Mr Cooke, who added that it was too early to determine whether the slower take-up since the summer would continue. He added that the 100,000 target remained appropriate.

Analyst Ian Hunter with Goodbody Stockbrokers also said that the fact Tysabri subscriptions had not fallen as much as expected was a "positive riposte" to those who believed the enrolment numbers would shrink more significantly.

- John Mulligan"

http://www.independent.ie/business/i...s-1508045.html

Cherie

Not sure why the above business article was posted.

It has to do with a manufacturing plant for Elan's drug delivery unit. Elan manufactures drugs that are developed by other companies, that use Elan's proprietary nanotechnology drug system, where they are able to reconstitute a drug by making it into nanosized particles that are more easily delivered into the body (think very small molecule) thereby using less of a drug to gain more benefit.

Tysabri scripts declined less than 1% overall, most notably during vacation time. It is thought that the PML cases did not have an effect on people who were on Tysabri and that most people who were on Tysabri chose to stay on Tysabri, with some people who were considering Tysabri either going ahead with it or choosing to wait until more investigation was done.

Elan does not manufacture Tysabri. Biogen Idec does. Although Elan invented Tysabri, their agreement with Biogen Idec provides that Biogen manufactures and controls Tysabri in the US, and Elan controls ROW, with Biogen manufacturing Tysabri for worlwide use.

As for the generation of profits, there are agreements in place where for every certain number of patients on Tysabri, Biogen must pay Elan a royalty above the normal profit share.

I could elaborate on this but this thread is for Tysabri users for information and questions about using Tysabri, not a business thread, so I will refrain.

The reason this matters to Vic (and others), is that he no longer able to take this med because of COST, and the continuously growing cost of the med and/or infusion center charges is very relevant for many people who are on or are wanting this drug.

Most of the “news” in that article was very good (at least that’s the way I saw it), but it was COST factor that I was posting to. Vic had brought up that 43 out of the 48 patients had to stop taking this drug because of infusion costs, and this article suggests that for every 10,000 people on Tysabri, the company generates 100,000 million in profit (NOTE: not revenue, but PROFIT).

I didn’t realize that this was something we shouldn’t be talking about here, so I will seek more clearly defined parameters for this thread with the administration.

Cherie

talking about and debating are different things vic.

BTW...I thought I asked rather nicely that if anyone wanted to dicsuss this they do so by PM. :rolleyes:

Vic - I thought you figured out the incorrect billing going on and that you might/would return to Ty.

In looking at my bills for the two Ty treatments I had...the med itself was around $2500 and the rest of the charges were less than $500. The center billed Blue Shield (of CA) for $2,956.00, and BS "approved" $2,624.66 - meaning that was the allowable amount. And from that, I have a 20% copay - leaving me with around $500 to pay.

What I have never understand from your experience is HOW and WHY the infusion center was charging you exorbitant amounts.....and why you weren't able to check other infusion locations. It is definitely concerning to me.

I also have wondered....and I hope I'm not being TOO nosey....is does your insurance policy have an Out of Pocket Maximum for the year? My policy has a $4,000 out of pocket max. Once I hit that - then all of my copays are covered and I pay nothing. This is different than a deductible (of which mine is currently also $4000). I have a PPO plan.

The biggest "bummer" about my plan is that injectibles - like all the CRABs are covered under PRESCRIPTION benefits - which do not fall into the out of pocket maximum limit. So all of my meds, I have to pay, though the negotiated rate. But now that I'm back on Copaxone - my copay is close to $600 for that alone :eek:....but I'm VERY fortunate to be receiving assistance from the Chronic Disease Fund.

However, between now and December 31st, I plan on getting as much medical care as possible.......since it won't cost me anything (as long as I'm in network - which with Blue Shield PPO, it pretty much covers anything).

Through the years when I watched my mother chronically and terminally ill....I learned alot about insurance....and I own my own business, so I got to choose our plans.

I guess I should be thankful - BS has been VERY good to me. They approved the HiCy treatment within 5 minutes of receiving the request. When I had gastric bypass surgery 4.5 yrs ago, they approved that within an hour. My MRIs have always been covered. When I needed provigil or other off-label meds, they've approved.

And most interesting is that a nurse case manager has been calling me to follow up on my recent hospital stay/chemotherapy treatment (the HiCy)! Can you believe that?! Totally shocked me.

Oh, and any claims I file when I use an out of network provider....I get my reimbursement check within 10 days or so!

Vic - if you need any help with this stuff - let me know... Plus, I'm a New Yorker....and I've been known to go "NY on people" :)

Be well,

~Keri

ps/I still think you should look into HiCy!