Synagis shot for RSV - outrageous!

Ok, I just had to vent about this one. I am in total disgust at the pharmacutical industry. My twins were born early and were in the NICU for 6.5 weeks. They had to get the Synagis shots for RSV, once per month for the duration of RSV season (which ended in April). I heard they were expensive but I received the bill for the shots...... are you ready for this????

ONE SHOT, FOR ONE BABY, FOR ONE MONTH - $7,091.00 - YES YOU READ THAT CORRECTLY.....SEVEN THOUSAND DOLLARS FOR ONE SHOT!!!!!!! (Ok, to their defense, one vial, which is 50 mg is $3,545 - however, the amount given to the child is based on his weight, so for example - my 8 lb daughter in February needed 57 mg - so they had to open 2 vials to get that much, so you are charged for the two vials - hence the seven thousand dollars.)

They had their first two shots while in NICU, then we took them in for February shots and March shots (apparently RSV was not bad here this year so they said we didn't have to get the April shot). So, that is 4 shots, for a total of $28,364!!!! And, they said the twins will need them again next year for the entire RSV season which is September through April!!! OMG!!! That would be a total of $113,456 to keep my babies from getting RSV. Actually, it would be more because since it is based on their weight, they would need a higher dose!!!! This is highway robbery! Thank GOD we have insurance, but even after they pay 90%, that is 10% for us.... So, what if you don't have insurance, your babies don't get to be protected from RSV? Unbelievable.....

Ok, it felt good to get that off my chest..... LOL

 

Holy CRAP! In my state medicaid will pick up the tap after 30 days in the NICU. Does yours? I don't even want to see the bill from the boys stay. We were there as long as you were. I'm happy with Medicaid and my health insurance just paying it all.

evie

 

That's insane! My boys were in the NICU for 4 weeks and their NICU bills were $58,000 and $82,000 (cpap). That's almost the same price as the synagis shots! Crazy. Thank goodness for insurance.

 

It is crazy. But, I've heard it's so expensive because it's not a vaccine, rather it's pure antibodies -- that's why you have to get it monthly.

Our insurance company declined to cover it for my two, even though we met several of the risk factors -- preemies, older child in preschool, and one baby with another respiratory issue. I was so angry....thank goodness they didn't get RSV this season!

 

Yup they are totally expensive but well worth it if you can qualify for them. We had them the first season but we did not qualify this past season and I was totally bummed.

 

We had to put up a huge fight with the insurance company to get ours covered. (Our girls weren't in NICU, but they were 4 weeks early. Our ped strongly recommended the shots). A rep from United initially told me it would be covered at 100%. Then I got a bill for the 10% co-insurance and almost died!! When I called the rep to tell her she gave me the wrong info, she had been transferred and was no longer our rep and the new rep told me I was responsible for the 10%. WHAT?!?!? :angry:

Luckily my husband is in HR and has a great relationship with the benefits manager (who has a sister with frat twin boys) and she managed to get ours covered at 100%. Luckily his company is self-insured. There was another set of twins that were told the same thing by this incompetent woman and their's got covered at 100% too.

We will not be going through this again next year. I'll put them in a bubble first.

 

So your insurance didn't cover them? Did you ped let you know your insurance didn't cover them?

My two got them the first winter, but our insurance covered them since they qualified for them. Not everyone qualified for the synagis shots, being early is not a guarantee for qualifying for them, neither is being in the NICU, it's sad.

We did not qualify for them this past winter though, even though they were born 3 months early, I was told they were too healthy for them.

 

Shocking isn't it! Just goes to show how high the risk is that your babies would get RSV and end up hospitalized! Otherwise, there is no way that any ins. co. would agree to pay these huge amounts!

 

We had to get 4 synagis shots this year per child and thankfully our insurance covered it at 100%.

 

QUOTE(summerfun @ May 10 2008, 09:55 AM) [snapback]765865[/snapback]
So your insurance didn't cover them? Did you ped let you know your insurance didn't cover them?


Well, yes luckily my insurance did cover the shots (90%). I just think the cost is ridiculous - seven grand for a 57 mg shot for an 8lb baby!!! GEEZ!!! Also, we will definitely meet our family out of pocket maximum so if they need the shots this fall, they would be covered 100%, until January anyway. Lord knows I don't want my babies to get RSV though.....

 

My insurance only covered 2 doses (each), while they were in the NICU. When we got them home, they would not cover them so we did not get them.
I was extra careful and the were fine but I'd rather have gotten them.

 

Ours weren't covered either and I work in the ER. I can't tell you how many RSV babies we saw this past winter and I was constantly bringing it home to our two early babies. Not enough of a risk for insurance to cover it and we couldn't afford the shots out of pocket Needless to say, I disinfected myself at the door every day coming home from work.

 

My girls were born 4 weeks early and I asked before leaving the hospital for the shots. They said they did not qualify since they were not on any breathing machines.

Well 6 weeks later we were in the hospital with RSV. I still feel guilty that my girls had to go through that. How they got it I have no clue but it was horrible.

 

QUOTE(Becca34 @ May 10 2008, 12:04 PM) [snapback]765676[/snapback]
It is crazy. But, I've heard it's so expensive because it's not a vaccine, rather it's pure antibodies -- that's why you have to get it monthly.

Our insurance company declined to cover it for my two, even though we met several of the risk factors -- preemies, older child in preschool, and one baby with another respiratory issue. I was so angry....thank goodness they didn't get RSV this season!


[SIZE=10pt]
Our insurance company denied us too! I was so mad ~ we were really nervous all seson..luckily we made it through this year.

April [/SIZE]

 

Our boys were in separate NICUs. The first one to get released got the Synagis, standard protocol for any baby in that NICU (a level II). The other baby was in a Level III in a different hospital - we asked and they said no, despite him having issues that they couldn't diagnose, and there were some questions about his heart!

Our pedi petitioned insurance for us, and we were denied. The pedi yelled at them for us, but still no dice. She felt so strongly that we needed it - what with a dozen hospital visits, visiting nurses, and Early Intervention teams tracking in and out of our lives - that she donated it for us out of leftover stock. She said that we didn't have the OPTION of keeping them isolated (which is what she normally tells parents who can't get it covered to do), and she absolutely did not want to take chances.

We're so grateful to her, really. The cost is just unbelievable!

 

QUOTE(Ryan & Emmy @ May 10 2008, 11:12 AM) [snapback]765890[/snapback]
Well, yes luckily my insurance did cover the shots (90%). I just think the cost is ridiculous - seven grand for a 57 mg shot for an 8lb baby!!! GEEZ!!! Also, we will definitely meet our family out of pocket maximum so if they need the shots this fall, they would be covered 100%, until January anyway. Lord knows I don't want my babies to get RSV though.....

Well that is good they were covered. You are right the cost is ridiculous. <_< I'm glad they will be covered next year, if needed. I personally feel every baby should get them. My niece was full term and got RSV at 6 months old and ended up in the hospital.

 

WOW! My girls were born 10 weeks early, we never did the shots and they are 2 y/o and have never had RSV.

Edited: It was our personal decision not to do the shots, our ins would have covered them 100%.

 

That seems outrageously high. I realize the shots are expensive, but I think the maximum per child per shot we got to was $2500. I would question that, because even 10% of that is outrageous.

We did not get the shots the second winter, they were not covered by insurance, and my DD's were 9 weeks early. Besides a few colds, they were fine, even though they started in daycare late winter.