Meeting with Dr. Kane went well………………Prescription copay; ouch!
The meeting with Dr. Kane went really well today. We discussed the results of the recent PETscan and she reassured us that although the tumors had grown slightly she wasn’t overly concerned. She said that since Mom has begun receiving the Avastin and increased her dosage of the Folfox she is optimistic that we will see a better result with the next PETscan. She wants to complete 3 rounds of the treatment and then conduct another scan. Although the tumors had grown, it was not significantly. We have several options for treatment depending on the results of the next PETscan. If the tumors respond well to the Avastin and are smaller on the next scan then we will continue with the present course of treatment. If the tumors show no change or increase in size again then they will change Mom’s chemo treatment from the Folfox to Folfurion. The difference is the substitution of one drug of the mixture. I felt reassured that regardless of the results of the next scan, there is a plan in place.
Now, in Most Ridiculous CoPay news………. holy shit batman. I have often talked about Mom’s ongoing battles with her platelet levels. There is an drug, called Neupogen that is supposed to help with platelet production. It is administered with daily injectables that you can administer to yourself. Dr. Kane mentioned that it was expensive and said not to fill the prescription if insurance wouldn’t cover it. One of Mom’s nurses had previously mentioned Neupogen to Mom when discussing her platelet dilemmas but said that she hadn’t seen much success with it. But we decided it was worth trying anything to keep her chemotherapy treatments on schedule and Aetna has been so wonderful with their coverage; prescription and medical. We dropped off the prescription and discovered that a 10-day supply costs $3600! Yea, Wow. Our Copay through Aetna would be $919 because the enormous cost for this drug quickly shot Mom over her $5000 annual maximum prescription coverage with Aetna. This would cause Mom to have to pay out of pocket for all of her future prescriptions for the remainder of the calendar year. We decided not to go with the Neupogen injections. With the poor reviews about the drug and Dr. Kanes unenthusiastic endorsement and the enormous cost has led us to the decision to cancel/not fill the prescription. Besides, Mom wasn’t really looking forward to having to administer daily shots to herself anyway.
This leads me to another rant. This all would not have been as much of an issue if we could find a pharmacy that accepted Texas Medicaid, Mom’s secondary insurance. The hospital accepts it for medical treatment so why would the pharmacy not accept it? We are trying to find a way to remedy the current situation. Either Mom could find a doctor that will write prescriptions in Texas with a referral from Dr. Kane and ship them to her in Colorado. That way Medicaid will pay 100% of anything left over from her Aetna coverage. The 2nd option is to transfer her from Texas Medicaid to Colorado Medicaid. I will be calling on Monday to find out if this is an option. Since she is a Texas resident I’m not sure this is possible but a few people we have spoken to are convinced it is.
Long story short, today was a wake up call that I need to get back on the fundraising wagon. We just can’t get too secure or confident that we are prepared. There’s always the possibility that a huge unforseen expense, like a $3600 drug!, can jump out of the bushes and catch you off guard.
