I thought this would get simpler!!!

November 10, 2009

Let me start with today and go back that way when it gets boring you can check out.

We started a new chemo regimen today. I am now on an every three week cycle of Altima for chemo. Its side effects require the concurrent use of vitamin B-12 and Nulasta injections. A five day anti-emetic, a 20 mg of dexamethaxone injection just prior to chemo, folic acid every day and dexamethasone for three days including the day of chemo. The expected total for each visit is between $12-15,000. The Altima is hard enough on the white blood cells that Nulasta is a normal part of every treatment. It fortifies and rebuilds white blood cells. The Nulasta dose is about 5ml and is billed at $,5000 per dose. The Alimta lists on drugstore.com for just under $3,000 per dose. The nurse thought the billed cost for the injection was double that. We are attempting to get on Fragmin - a heparin based anticoagulant. The cost of it is supposedly under $500 per month as a daily injection.

The major problem we are dealing with at the moment is blood clots in my legs and the changes to our pharmacy reimbursement as a result thereof. As described by our agent for Blue Cross, "a perfect storm" occurred in the Cities employees resulting in a major increase to our insurance costs. The insurance quandary first.

Last year more than a third of the participants in our City plan had pharmacy cost greater that $5,000 This coupled with an increased number of employees at the City resulted in the group being rated completely on its own past history. Previously the City employees had been grouped into a larger database that spread the use out over a greater number. The end result being a $6,000 per year cap ($1,500 per quarter) on pharmacy benefits and a change in our major medical from 80/20 to 70/30.

To date the biggest problem is the cancer medications I was on. The Tarceva cost in excess of $3,000 per month. The copay was $75 for 3 months. Now I can still get it but there is a 50% copay. The Arixtra, for the clots, was $75 for 3 months but costs even more,over $200 per dose each day. My copay would have been over a thousand dollars per month without any of the supporting or regular prescriptions. Talk about a perfect storm!!