Has anyone had any luck at having medicare pay for rocephin at home? They will evidently pay if I'm able to get to an infusion center on a daily basis - not likely at this time....plus local infusion center only open M-F. Thanks, Deb
Posted by duramater (Member # 6480) on :
I know those are the old rules, but now, with the Part D plan, it may be different. Check your Part D pharmacies, some of which are home infusion companies. Part B should pay for the things like needles, iv pole, nursing, etc.
Posted by Biting Back (Member # 6018) on :
Hi Deb,
No luck for me, medicare wouldn't touch it with a ten foot IV pole. They don't seem to get the gist of the phrase 'cost effective' . . . home health care costs much less than in-hospital care. Go figure.
I think I'm going to look into medicare part D as well. Good luck.
Posted by deb obrien (Member # 5239) on :
Hi Dura and Bites - thanks for your replies, the saga continues..vna won't even tell me the cost unless they have a definite order (I'm guessing at least $300/day for rocephin) and the drug cost won't be considered under medicare part D...so i need to do this on my own (i used to be an rn so mixing and infusing is no problem) I just need a total list of supplies that I can have a doc order from a compounding pharmacy - this will be relatively cheap and I don't mind paying for it... thanks again, deb
Posted by trueblue (Member # 7348) on :
Deb, Check into Roche's PA assistance program; they have been very generous with Rocephin in the past.
I did a course of Rocephin as an IV push about 5 years ago. Medicare wouldn't touch it as home therapy but I was able to buy all the supplies and administer it myself at home; but at least the med was free.
I also had to make arrangements for everything (including having a picc line inserted).
If you can meet Medicare's definition of homebound status you may be able to get home nursing. 5 years ago it was almost impossible and they may not do it at all, now.
I'm looking into IV treatment through an infusion center in the near future and can't see how it'll work.
As far as I can tell, Medicare will pay for 28 (consecutive) days of treatment and/or maintanence and then you're done. (It sounds like for life! )
I wonder how this will work with a q12 dose of meds and the center not open those hours?
If any of you guys have done this or know anything more about how it works could you shoot me a PM?
Thanks!
Posted by chainsaw joseph (Member # 6611) on :
Medicare has payed for my last couple of months IV generic rocephin.The medacine cost just under 400 a week then theres the infusion co cost and supplies.
Posted by duramater (Member # 6480) on :
Coverage is based on which Part D plan you have. Rocephin is covered on my formulary as is Primaxin and other IV abx (which is why I bought this particular plan). Did you call the provider specifically?
All VNA costs are covered under Part B. I've had gobs of VNA care over this past year and they are paid in full by Medicare. "Durable goods" like IV polls and pumps are handled just a bit differently.
It will take a lot of research on your part and calling back multiple times to Medicare and your part D provider. You will likely get a few different answers based on who you talk to, but keep at it.
Posted by lymiebabe (Member # 8890) on :
Wow - just got online to ask the same question. I'm in New Mexico, and I have gotten so much run-around that I've spent all my energy for weeks on trying to get IV
Rocephin coverage. BTW - the Rocephin Patient Assitance program shut down last year. I don't care if I have to give the IV's
myself at home - I can do this - I just ned help with the meds and the PICcline. Can those of you who said you have gotten in please let us know what you have as far
as medicare, medicare advantage, part D, private insurance, etc... -? I am so frustrated that I am ready to hop on a plane to Boston (where I got Lyme and used to
live,) or San Francisco (where I have friends and there seems to me to be more understanding of the disease and treatement.)
Thanks!
Posted by trueblue (Member # 7348) on :
Duramater ~ what is/are VNA care and/or costs?
I haven't seen a medicare part D plan I can afford, in my state or found one that covers IV meds at all.
I have no secondary coverage and am ineleigble for medicaid or extra help. I've been banging my head against the wall trying to figure out how to do this.
I can also administer meds on my own at home but need the picc, meds and supplies. If anyone with suggestions on how to do this could post or PM I'd be eternally grateful.
For far too many years my treatment has been dictated by what I could get in samples and PA programs; I have been not been treated effectively as a result. (As a result of the part D thing there are more PA programs going belly up.)
I'm ready to take it on my own and get this thing done but can't seem to get a foot in the door. It's extremely stressful and frustrating and can't find any help in sorting it out.
thank for any help anyone can provide.
Posted by twobusymom (Member # 3956) on :
I have no insight on the reimbursement of the med through Medicare but I was a home health nurse and office manager for years.
MC is all about home bound status but there are MANY ways to be home bound. If you are unable to tolerate the extensive time out of your home for treatment you are considered homebound.
If your immune status is weakened (arent we all???) you are home bound.
It is ALL in the documentation and the willingness of the agency providing your care. I can say I was never dishonest in providing care but I delved very deeply into physical, mental, emotional factors in determining a patients status.
Not sure about anyone else, but there are lots of days that I just mentally can not force myself into a situation of dealing with others.
There are days when driving my car is so frightening to me because of paranoia or heart palpitations.
One other thing that might help is that home health CAN come in to do instruction on PICC or central line site care, IV infusion, etc.
I had this a couple of years ago when I did IV Rocephin. I was not eligible for MC at the time but my private insurance reimbursed for this service.
I know most private insurance will reimburse for home care if there are no other facilities open at the time that administration is required. BUT the growing trend is that the agency instruct and get the patient self sufficient.
The days of going into someones home every day, two or three times a day went out the window many years ago with the MC reform. Which in my opinion was not entirely a bad thing.
If you are not or a family member is not available or instructable or able due to limitations, MC will give a higher rate of reimbursement to the agency for the visits but the agency will still try to instruct and pull out except for monitoring as quickly as possible.
As with all health care, its all about the money. Dont miss that part of it at ALL!!!!!
Hope some of this helped. Has just been part of my experience from both sides of the needle
Cheryl
Posted by deb obrien (Member # 5239) on :
Hi Dura and Chainsaw,Two busy and others - I'm soooo impressed that you guys managed to get IVs's at home with medicare....I, also was once a visiting nurse and could become pretty creative with the homebound qualification. I have medicare part A, B. & D.
No infusion co in this area will do home infusions under Medicare (maybe it's the lyme dx!!). I have part D with AARP - United Health Care- which is Walgreen's baby. I can get rocephin from them (not from Costco where I usually go). I can get supplies from Curia Scrip - not included under part D).
Where I've been stalled the last week or so is getting my LLMD to contact my local primary MD - she was a bit blown away when i asked her to order a PICC line insertion - understandably she wants to talk with the lyme expert....lyme expert's nurse is trying to facilitate the communication.
I didn't understand when I saw this guy that he basically doesn't do follow-up, he evidently expects everything to be done at his office during the visit (he no longet takes medicare so that was $600 cash,folow-ups are $300!!) He simply gave me a piece of paper that said groshong and 2 gm rocephin daily. Maybe that piece of paper would work at the hosp where he is a practicing doc but not over on this side of the bay...
If this is longterm I know I will soon blow through the donut and get catastrophic coverage. Every week or so I will have to go to the local infusion center and get a dressing change and stat lock change - the IV supply folks I"ve talked with don't carry stat locks and the guys who put in the piccs locally won't suture them in....
But, I'm still really looking forward to this as I keep deteriorating!!! and am very much homebound.....
Thanks for all your replies...
Deb
Posted by kirstenr (Member # 9071) on :
My dad has Lyme with neurologic complications, and he also has Medicare parts A, B, and D. He saw Dr. Harris up in Nevada City, who recommended fifteen months of 2 g/d of Rocephin. Dad's primary is coordinating the care down here. Dad got a PICC line this week and he's had 5 infusions at the doctor's office and in the hospital. We're going to do the infusions at home as soon as we get everything lined up. We want to have a home health nurse come out and train us for a couple of days. I found out that Costco has a great contract with one of the manufacturers of generic Rocephin -- we can get 30 two-gram vials of powdered Rocephin from them for $474. But the home health agencies are telling us that Costco is not allowed to sell home infusion prescriptions. I called Costco and told them the home health agencies were telling us this and Costco said they could get the generic Rocephin for us. The home health agencies tell us we *must* have the prescriptions delivered by a home infusion pharmacy. Who is telling us the truth? We expect Medicare to pay for at least the first 28 days but want to go with the most inexpensive route in case they don't, right?
The other thing is that the home health agencies will not have the Rocephin delivered in powder form, it will be in solution that has to be refrigerated. And they want the Rocephin to be packaged in a syringe so that delivery is done using "push" instead of a drip. Does anybody know why they would do this? I would think the drip is better because the rate can be adjusted.
Thanks for any help.
-Kirsten
Posted by bettyg (Member # 6147) on :
Welcome to the board! Breaking up your post for us neuro lymies who can't read as is.
Please hit the enter button often and double space between paragraphs to help us out. Thanks
quote:Originally posted by kirstenr:
My dad has Lyme with neurologic complications, and he also has Medicare parts A, B, and D.
He saw Dr. Harris up in Nevada City, who recommended fifteen months of 2 g/d of Rocephin. Dad's primary is coordinating the care down here.
Dad got a PICC line this week and he's had 5 infusions at the doctor's office and in the hospital.
We're going to do the infusions at home as soon as we get everything lined up. We want to have a home health nurse come out and train us for a couple of days.
I found out that Costco has a great contract with one of the manufacturers of generic Rocephin -- we can get 30 two-gram vials of powdered Rocephin from them for $474.
But the home health agencies are telling us that Costco is not allowed to sell home infusion prescriptions.
I called Costco and told them the home health agencies were telling us this and Costco said they could get the generic Rocephin for us.
The home health agencies tell us we *must* have the prescriptions delivered by a home infusion pharmacy. Who is telling us the truth ?
We expect Medicare to pay for at least the first 28 days but want to go with the most inexpensive route in case they don't, right?
The other thing is that the home health agencies will not have the Rocephin delivered in powder form, it will be in solution that has to be refrigerated.
And they want the Rocephin to be packaged in a syringe so that delivery is done using "push" instead of a drip.
Does anybody know why they would do this? I would think the drip is better because the rate can be adjusted. Thanks for any help. -Kirsten
Posted by deb obrien (Member # 5239) on :
Hi Kristen - This is a zoo, isn't it? I haven't even gotten my primary doc to talk with Dr S yet...she wants more info before ordering a picc.
Good news about the Costco drug prices, though, when I asked Costco they said they didn't carry it!! I will ask again.
Once I get the line in I can get the IV supplies from Curia Scrip 1-888 773 7376 - they have everything except for stat locks.
I think the easiest thing for you is to observe very carefully the infusion nurse at the Doc's office and then ask her to observe you on the next visit.
My guess is that home infuison companies feel that for accountability purposes (as well as profit) they must use their own drugs - also, they will not use part d of medicare.
Good luck, , Deb
Posted by twobusymom (Member # 3956) on :
Kirsten
Rocephin is safe doing IV push. It can be adjusted just as a drip, you just push slower.
If memory serves me right a single dose can be given over 5-10 minutes safely. Oh where did my memory go??? lol.
The reason for doing push is basically cost. It eliminates the need for IV tubing and those supplies. It also decreases the amount of time in the home by a health care provider.
Just a thought.
Cheryl
Posted by earthsong15 (Member # 7471) on :
ok- this is very much something that I should pipe in about. I have a groshong catheterin my chest and have been on IV rocephin for almost 6 months now.
The first 4 months I had to drive myself every morning to the hospital to get the infusion done. This was the only way that Medicare would cover it. I still had to pay $800 a month because the hospital charged $350 a day!!!!
Then I got in touch with the hospitals home infusion center and they had a very smart billing woman there. Medicare won't cover home infusions, but she knew of 1 company that had part D and possibly would cover it.
So, low and behold, I am doing the infusions at home and getting it paid for!!!! They come pre mixed in a baby bottle looking contraption, and are so easy. The nurse comes just once a week to do a dressing change and to bring me a weeks supply of medicine.
My advise would be to talk to everybody and someone will know a way to do this. Perserverence furthers!
Posted by burnbitter (Member # 7088) on :
quote:Originally posted by deb obrien: Hi Dura and Bites - thanks for your replies, the saga continues..vna won't even tell me the cost unless they have a definite order (I'm guessing at least $300/day for rocephin) and the drug cost won't be considered under medicare part D...so i need to do this on my own (i used to be an rn so mixing and infusing is no problem) I just need a total list of supplies that I can have a doc order from a compounding pharmacy - this will be relatively cheap and I don't mind paying for it... thanks again, deb
sutter vna? if that's who you called, I also called, and really didn't like them. I also called crescent healthcare and they seemed much nicer, though didn't have prices either. but it seemed like they were willing to work with people on getting the best price. Sutter VNA said they could only use drugs from their pharmacy.
Posted by kirstenr (Member # 9071) on :
Hi, this is Kirsten again. I know more than I did last time I posted and I thought I should share, in case it can help anyone.
It isn't true that you have to have home infusion prescriptions delivered by a home infusion pharmacy -- we picked up Dad's prescription for Rocephin (generic) yesterday at Costco. Medicare Part D covered all but the $5 co-pay. My understanding is that if we had used a home infusion pharmacy to fill this prescription, it would have been delivered to his house and Part D would not have covered it.
However, it is very difficult to find a home healthcare service who will send someone out to train you unless you have the supplies and prescriptions delivered by their pet home infusion pharmacy. I found two out of about a dozen that would just send a nurse out to use supplies and prescriptions we were stocked with to teach us how to do the infusions. I don't believe this to be a liability issue so much as a profit issue. Many of the supervisors I spoke with at the home healthcare agencies had all the scruples and integrity of a funeral home director, and I mean that in the worst possible way.
A home infusion pharmacy has delivered 30 days worth of all the supplies Dad will need other than Rocephin and we're using them just this once to get us started. After this, we'll be picking up the scrip for the heparin (needed to flush the PICC line) at a pharmacy that accepts Part D and picking up the non-prescription supplies at a specialty pharmacy that will sell them to us over the counter as long as we have a doctor's order (or perhaps using Curia Scrip if they're cheaper -- thanks for the info, Deb). I found an over-the-counter specialty pharmacy in a nearby town. This will save approximately two thousand dollars a month (one thousand on prescription medications and another thousand on supplies such as tubing, saline bags, syringes, etc.).
The cheapest way to get the generic Rocephin at Costco is in 10-packs, and if you buy three at once it's cheaper than getting three separate 10-packs. So Deb, when you call Costco, ask what the best price is on a 30-day supply. It may be that some of the Costco pharmacies are staffed with sharper personnel than others. The woman I talked to made phone calls and called me back twice. She had to add it to their system because no one had ordered it before. It may be a new product for them.
The Rocephin is hard on tissue and we've been told that it needs to be delivered over a 30-minute period even though it's being delivered into a large vein that dilutes it right away.
It helps so much to know that we aren't the only ones hitting roadblocks. Thanks, all, and the best of luck to you.
![[shake]](graemlins/shake.gif)
![[Frown]](frown.gif)
)![[Smile]](smile.gif)