ST. LUKE’S CHARGE 10002800 IPILIMUMAB 50 MG/10ML IV SOLN Insurance and Self Pay Discounts 250 J9228 0003-2327-11 $790.62

Overview:
Ipilimumab (Yervoy) is an intravenous immunotherapy medication used primarily to treat certain cancers, including melanoma, by enhancing the body’s immune response. The listed charge covers a 50 mg/10 mL IV solution (CPT code J9228) and includes the medication supply and standard preparation fees. Costs vary widely depending on insurance coverage, with significant discounts for self-pay patients. For clarity on your financial responsibility, always request a detailed, itemized estimate from the provider and consult your insurer about negotiated rates, copays, and deductibles.

Cost Breakdown

  • Standard Fee (per 50 mg/10 mL unit): $790.62
  • Self-Pay Discounted Fee: $426.23
  • Insurance Minimum: $395.31
  • Insurance Maximum: $672.02
  • Example Insurance Rates:
    • Aetna PPO: $659.36
    • Anthem PPO: $672.02
    • Cigna PPO: $668.80
    • Humana HMO: $189.83
    • UHC PPO: $668.87
    • Common Ground: $240.57

Associated Costs

  • Administration fees for IV infusion (not included in drug cost)
  • Facility fees for outpatient or inpatient care
  • Pre-treatment lab work and physician evaluation
  • Post-infusion monitoring and follow-up visits

Insurance & Payment Advice

  • Confirm your plan’s coverage and out-of-pocket maximums for specialty drugs like Ipilimumab.
  • Ask about prior authorization requirements, which are common for high-cost cancer therapies.
  • Check if manufacturer copay assistance or hospital financial aid programs are available.
  • Request a pre-treatment cost estimate, including all associated facility and professional fees.

Side-Effect Considerations

  • Ipilimumab can cause immune-related side effects affecting skin, gut, liver, or endocrine glands.
  • Some side effects may require additional medications, monitoring, or hospital care, leading to extra costs.

Recovery & Support Tips

  • Arrange transportation to and from infusions, as sessions may take several hours.
  • Monitor for symptoms such as rash, diarrhea, or fatigue, and report them promptly to your care team.
  • Schedule follow-up appointments to track treatment response and manage side effects.

Frequently Asked Questions

  • What is Ipilimumab used for?
    Ipilimumab is an immunotherapy drug primarily used to treat advanced melanoma and other selected cancers by enhancing the immune system’s ability to fight cancer cells.
  • Does the listed fee include administration costs?
    No, the fee covers only the medication itself; infusion administration, facility fees, and other charges are billed separately.
  • How much will I pay out-of-pocket with insurance?
    Your cost depends on your specific insurance plan, deductible, coinsurance, and out-of-pocket maximum. The negotiated rates shown are examples, but verify with your insurer for your exact amount.
  • Is financial assistance available for this medication?
    Yes, many hospitals offer financial aid or payment plans. Drug manufacturers may also provide copay assistance for eligible patients.
  • Will I need prior authorization from my insurance?
    Most insurers require prior authorization for high-cost specialty drugs like Ipilimumab. Confirm with your provider before scheduling treatment.
  • Are there additional costs to consider with Ipilimumab treatment?
    Yes, you may incur costs for lab tests, physician visits, infusion administration, management of side effects, and follow-up care.
  • How often is Ipilimumab given?
    Dosing schedules vary by diagnosis and treatment protocol, but it is typically administered every 3 weeks for several cycles.
  • Can I get a detailed estimate before starting treatment?
    Yes, you have the right to request an itemized estimate showing all anticipated charges, including medication, administration, and facility fees.
  • What should I do if I experience side effects?
    Contact your oncology care team immediately. Some side effects may require urgent treatment or hospitalization, which could affect overall costs.
  • Does Medicare or Medicaid cover Ipilimumab?
    Coverage varies, but both Medicare and Medicaid typically cover medically necessary cancer treatments, subject to plan rules and possible cost-sharing.
  • Can I bring my own medication to the hospital to save costs?
    Most hospitals require medications to be sourced through their pharmacy to ensure safety and compliance, so bringing your own is usually not permitted.

Aurora ST. LUKE’S
CHARGE
10002800
IPILIMUMAB 50 MG/10ML IV SOLN
Rev 250
CPT J9228
NDC 0003-2327-11

Fee $790.62

Self-Pay $426.23

Insurance

Minimum $395.31
Maximum $672.02
Aetna W $389.17
Aetna PPO $659.36
Anthem Blue Priority $244.99
Anthem Blue Preferred $244.99
Anthem PPO $672.02
Aurora Caregiver $182.70
Centivo $225.63
Cigna GPPO $473.79
Cigna PPO $668.80
Common Ground ETF Network $240.57
Common Ground Exchange Envision $240.57
Common Ground Group Envision $240.57
Everpointe Elite $234.65
Health EOS Plus $482.28
Health EOS PPO $632.50
HealthPartners ETF $218.77
HealthPartners Robin Focused $273.30
HealthPartners Broad $592.96
HPS $247.77
HST $385.81
Humana HPN $189.83
Humana HMO $189.83
Humana PPO $668.80
Molina Exchange $410.70
Quartz One $385.77
Quartz Group $462.85
Trilogy $430.05
UHC Individual Exchange $180.61
UHC Charter $180.61
UHC Nexus $180.61
UHC HMO $181.49
UHC PPO $668.87
WPS Aurora Featured Network $404.92
WPS Arise $426.23
WPS Statewide $426.23