Insurance Woes

On Tuesday, I picked up the new oral chemotherapy medications from the pharmacy.  

Chemo drugs stay in light-protective bags in the refrigerator.  Just under our milk.

One month's worth.

 

 

I was warned repeatedly by the pharmacist to make sure we get gloves to use at home when handling these outside the bag.  Protect myself, but poison my child...

It has been quite an ordeal to acquire these.  There are two different drugs: cyclophosphomide and topotecan.  Last week, the pharmacy called me to say the cyclophosphomide was not covered by our insurance, so I needed to call the insurance company to discuss with them.  I did, and they said they had it figured out and it would be covered.  While I was on the phone, I had them check for the other two drugs, topotecan and erlotinib, she would need over the next 6 months; they said it would not be a problem.  Wrong.

When I arrived for Scarlett's clinic visit this week, the story was different.  Scarlett's NP and the pharmacists spent more than 3 hours on the phone with the insurance company to fight to have them approved, but only the cyclophosphomide was going to be allowed.  This is the same drug she has had every cycle for the last 6 months.  The new drug, topotecan, is not covered, and will not be covered. 

She needs this drug for 10 days in August, October and December (the "A" cycles of maintenance chemo).  For 10 days worth of doses, the cost for us is $1500.  That's $150 per dose. 

Luckily, our team knew that was way outside our means.  They arranged to have the hospital sponsor us for this round and provide the medication free of cost (as long as I fill out the pile of paperwork required and submit a second pile of supporting documentation of our income, insurance, accounting, expenditures and a written statement asking for assistance.)

We have two weeks left of this coverage.  We don't know yet if our new insurance will cover the chemo.  We do know that it is a much less comprehensive plan, and we will have much higher costs.  Our only hope is that we can finally qualify for Medi-Cal and other state programs once I officially have no income...though that brings about a whole different problem of paying all the other bills.

I am so tired of worrying about what will happen to us.  Everything has worked out so far, and I am just hoping that we continue to find solutions.  We keep telling ourselves it can't get much worse, but then we get hit again.

In other news, here's a sneak preview of what Scarlett did today...

And...we finalized the details for the blood drive!  It was suggested that we keep it simple officially, but expect to see some of your fun ideas in our advertising!  So...

Scarlett's Birthday Blood Drive

October 22, 2011

10a-4p

First Presbyterian Church of Newark

35450 Newark Blvd.

Newark, CA 94560

Sponsored by Stanford Blood Center

Donation requirements here

For those who can't attend but would still like to donate, our blog will celebrate our first Red October, with the goal of having as much blood donated as we can.  No special instructions, just be ready to donate in October and let us know about it!  If you have never donated blood before, you have a while to psych yourself up for it!  More to come...