Internet Sandostatin Cost Survey

 

Summer 2003 by:
Eugene A. Woltering, MD, FACS
The James D. Rives Professor of Surgery and Neuroscience
Chief, Section of Surgical Endocrinology
Director of Surgical Research
Louisiana State University Health Sciences Center
New Orleans, LA 70112
telephone (504) 568-2344
fax           (504) 568-4633
pager       (504) 679-7977
cell          (504) 884-3555

 

Sandostatin® is currently reimbursed by Medicare under what is called a “J-code”. Interestingly, any form of Sandostatin (aqueous or LAR) is covered by this J-code; 1 mg of Sandostatin is reimbursed at $88.69/mg. Thus, whether a patient receives a 10, 20, or 30 mg dose of LAR, the cost per mg is the same. Not only is the cost per mg the same, but the same J-code is used for all doses. Therefore, if you get LAR 10 mg, your supplier bills this J-code ten times for LAR; for LAR 20 mg, they bill this J-code 20 times. In contrast, octreotide acetate aqueous form is commonly dispensed in 5 mg multidose vials. The reimbursement for this aqueous injectable somatostatin analog is identical to the LAR form (i.e., the reimbursement for 5 mg is $443.45, or J-code billed 5 times).

 

TABLE 1.

LAR Dose (mg)

W.A.C.

Cost

Medicare

Reimbursement*

10

$1,300.64

$886.90

20

$1,493.76

$1,773.80

30

$2,007.29

$2,660.70

5

$785.05

$443.45

 

 

 

 

 

 

 

* Louisiana

W.A.C. – wholesale average cost

 J-code 2352 – $88.69 per 1 mg (any form of Sandostatin)

 

 

Thus, the actual cost of drug from Novartis is “set in stone”. Variations in what the drug costs an individual patient are not a reflection of the price that Novartis charges for the medication.

 

In an effort to understand the regional differences in the cost of octreotide acetate either in an aqueous or a long- acting (LAR) form, we performed an internet survey. No personal patient identifiers were requested. Patients supplied the form of their octreotide use (LAR vs. aqueous), the dose that they were using per month, and the cost of that dose. Many patients supplied additional information on the cost of medication when it was obtained from a pharmacy or from their physician’s office. The only other information requested was the state or region in which they live. Data was collected, and was sorted by form and dose of medication. This data was then analyzed to determine the mean and median cost of medication, and was further subsorted by the mean (± standard deviations), median cost, and maximum and minimum cost. (Tables 2 and3).

 

 

TABLE 2.

 

LAR Dose (mg)

# of Responses

Mean

± SD

Median

Minimum

Maximum

20

26

$3,511

$2,263

$2,971

$1,213

$11,910

30

42

$5,212

$2,867

$4,845

$1,333

$12,000

 

 

Following creation of mean and standard deviations, quartiles were created for LAR doses of 20 and 30 mg drug charges (Figs.1 a, b, c, 2 a, b, c). From these observations, it appears that there is a huge variance in the amount that patients are being charged for their Sandostatin across the U.S.  This survey suggests that, in general, the lowest costs are incurred when patients purchase their LAR from a pharmacy and “brown bag” the medication to their doctor’s office where it can be administered.

 

FIGURE 1A – BILLED CHARGES FOR A 20 MG DOSE OF SANDOSTATIN LAR

 

FIGURE 1B – MEDIAN COST OF A 20 MG DOSE OF SANDOSTATIN LAR

 

FIGURE 1C – MEAN AND STANDARD DEVIATIONS OF COST OF A 20 MG DOSE OF SANDOSTATIN LAR

 

 

 

FIGURE 2A – COST OF A 30 MG DOSE OF SANDOSTATIN LAR

FIGURE 2 B – MEDIAN COST OF A 30 MG DOSE OF SANDOSTATIN LAR

 

FIGURE 2 C – MEAN AND STANDARD DEVIATIONS OF THE COST A 30 MG DOSE OF SANDOSTATIN LAR

 

TABLE 3. 

 

State/

OA Form

Dose

Frequency

Dose/

Cost/

Cost/

Region

 

 

 

Month

Dose

Month

 

 

 

 

 

 

 

AL

LAR

20

Monthly

20

$3,100

$3,100

AL

LAR

20

Monthly

20

$3,068

$3,068

AZ

LAR

20

Monthly

20

$3,734

$3,734

CA

LAR

20

21 days

30

$1,800

$2,700

CA

LAR

20

Monthly

20

$4,800

$4,800

CA

LAR

20

21 days

30

$1,720

$2,458

CT

LAR

20

Monthly

20

$1,742

$1,742

FL

LAR

20

Monthly

20

$3,500

$3,500

FL

LAR

20

Monthly

20

$11,913

$11,913

IL

LAR

20

Monthly

20

$2,540

$2,540

LA

LAR

20

Monthly

20

$1,900

$1,900

MI

LAR

20

2 wks

40

$2,600

$5,200

MT

LAR

20

Monthly

20

$1,750

$1,750

NY

LAR

20

Monthly

20

$2,500

$2,500

OH

LAR

20

Monthly

20

$4,000

$4,000

OH

LAR

20

Monthly

20

$3,442

$3,442

OH

LAR

20

Monthly

20

$1,660

$1,660

ON

LAR

20

Monthly

20

1820 CAN

1820 CAN

PA

LAR

20

Monthly

20

$4,580

$4,580

TN

LAR

20

Monthly

20

$2,752

$2,752

TX

LAR

20

Monthly

20

$6,000

$6,000

TX

LAR

20

Monthly

20

$6,840

$6,840

TX

LAR

20

Monthly

20

$3,490

$3,490

TX

LAR

20

Monthly

20

$6,000

$6,000

TX

LAR

20

Monthly

20

$2,874

$2,874

WA

LAR

20

Monthly

20

$1,773

$1,773

AL

LAR

30

Monthly

30

$2,500

$2,500

AZ

LAR

30

Monthly

30

$7,360

$7,360

AZ

LAR

30

Monthly

30

$4,700

$4,700

CA

LAR

30

2 wks

60

$9,180

$18,360

CA

LAR

30

2 wks

60

$12,000

$24,000

CA

LAR

30

2 wks

60

$9,180

$18,360

CA

LAR

30

2 wks

60

$4,457

$8,914

CA

LAR

30

Monthly

30

$1,600

$1,600

CA

LAR

30

Monthly

30

$6,900

$6,900

CA

LAR

30

2 wks

60

$2,500

$5,000

CA

LAR

30

2 wks

60

$2,216

$4,432

CO

LAR

30

Monthly

30

$9,772

$9,772

FL

LAR

30

Monthly

30

$5,961

$5,961

FL

LAR

30

Monthly

30

$6,000

$6,000

FL

LAR

30

Monthly

30

$7,000

$7,000

GA

LAR

30

Monthly

30

$2,400

$2,400

MI

LAR

30

Monthly

30

$5,550

$5,550

MO

LAR

30

2 wks

60

$2,165

$4,330

NC

LAR

30

2 wks

60

$7,450

$14,900

NC

LAR

30

Monthly

30

$4,890

$4,890

NC

LAR

30

Monthly

30

$3,285

$3,285

NC

LAR

30

Monthly

30

$6,000

$6,000

NC

LAR

30

Monthly

30

$3,800

$3,800

NH

LAR

30

Monthly

30

$5,280

$5,280

NJ

LAR

30

Monthly

30

$4,800

$4,800

NS

LAR

30

21 days

40

$1,600

$2,133

NY

LAR

30

Monthly

30

$2,600

$2,600

NY

LAR

30

Monthly

30

$3,228

$3,228

OK

LAR

30

Monthly

30

$3,250

$3,250

ON

LAR

30

21 days

40

2400 CAN

3200 CAN

ON

LAR

30

Monthly

30

2000 CAN

2000 CAN

PA

LAR

30

Monthly

30

$3,105

$3,105

TX

LAR

30

Monthly

30

$9,780

$9,780

TX

LAR

30

Monthly

30

$9,690

$9,690

TX

LAR

30

Monthly

30

$6,450

$6,450

TX

LAR

30

Monthly

30

$9,700

$9,700

VA

LAR

30

Monthly

30

$9,744

$9,744

VA

LAR

30

Monthly

30

$5,127

$5,127

VA

LAR

30

Monthly

30

$3,047

$3,047

WA

LAR

30

Monthly

30

$3,658

$3,658

WA

LAR

30

Monthly

30

$2,134

$2,134

WA

LAR

30

Monthly

30

$5,925

$5,925

CA

LAR

40

2 weeks

80

$3,452

$6,904

IL

LAR

40

21 days

60

$2,644

$7,050

MA

LAR

40

21 days

60

$14,534

$19,378

MI

LAR

40

Monthly

40

$5,280

$5,280

NE

LAR

40

Monthly

40

$4,900

$4,900

NY

LAR

40

Monthly

40

$3,548

$3,548

OH

LAR

40

21 days

60

$8,190

$8,190

OH

LAR

40

Monthly

40

$6,235

$6,235

MI

LAR

50

Monthly

50

$7,500

$7,500

OR

LAR

50

Monthly

50

$4,573

$4,573

CA

Pump

60

Monthly

60

$4,812

$4,812

CT

LAR

60

21 days

80

$2,230

$6,370

IN

Pump

60

Monthly

60

$8,000

$8,000

OH

Pump

60

Monthly

60

$10,189

$10,189

PA

LAR

60

21 days

80

$6,040

$8,530

VA

Pump

60

Monthly

60

$2,600

$2,600

VA

Aqueous

60

Monthly

60

$6,900

$6,900

NC

Pump

65

Monthly

65

$981

$12,757