Anyone know anyone?

Rash

Long story short, my wife has relapsed with stage IV metastatic breast cancer. It's now moved to her bone. Her new chemo cocktail is not totally covered by insurance (USA, USA, USA!). The most expensive single med (Enhertu) is covered, however the other three are not and the programs currently in place with each company to get the drugs for free/cheaper leave gaps we fall right through. We are taking the shake every tree approach to see if we can find a way to get the drugs for cheaper/free as continuing to pay out of pocket is not going to work for very long. She just finally started today after multiple delays and insurance battles.

Anyway if anyone here has a connection with respect to any of the following Pharma companies, we are all ears. If I know anything from reading triathlon forums, it's that a sample size of one is irrefutable science - whatever drug company hooks us up will be getting their very own one person trial!

Eisai - maker of the drug Eribulin (brand name Halaven).
Celenge Corporation a Bristol Meyers Squibb Company - maker of Abraxane
Teva - maker of Leucovorin

Rash

We may have shaken something lose on Abraxane (no thanks to you guys ). Following it up and will see in the coming days, but could bring this entire situation from financially crippling and impossible to painfully but potentially manageable.

"Never take no for an answer!" @AaronWebstey old dating slogan is still useful in 2020!

Glad I have this place that I can come to and make everyone a little sad and uncomfortable. Cheers!

wchevron

Have she tried drinking Lysol and shining a flashlight down her throat? I heard it works for Covid-19.

Rash

I told her to rub dirt on it - never even thought about the Lysol cure! We'll try that next. I love science.

M_Ware

@Rash to you and Alison.

KHilgendorf

Don’t forget, you can simply inject bleach. Sure, it’ll kill just about everything it touches, but if you happen to hit a cancer cell, score!!!

Does your annual out of pocket max through insurance not apply? I know 6-8 Grand isn’t “nothing” (though being triathletes, it is, amiright?) but it shouldn’t be crippling even if spread over the course of a couple years.

Aaron Webstey

I'm so sorry to hear about this. Even in Canada, cancer can ruin you financially. My wife's Dad had to flush like $20k of drugs when her mom died in her 40s of breast cancer. Not covered by insurance. Love from our family to yours and let me know if there is ever anything I can do.

Jenni

Have you tried contacting the insurance company to see if they would make an exception for the drugs they don’t cover? There is an appeal process where you request review by a medical director when they say something isn’t covered. I’d say if they cover one drug and the others are required it’d at least be worth a shot to see if they’d cover the rest too so that the $$$ they are putting towards the one drug isn’t wasted because it isn’t as effective without the rest. Not sure where you are/what insurance you have but I worked for a company in MI for many years, if you are in MI I’d be happy to reach out to some of my contacts if it would help.

Rash

Thanks. As is usually the case, things are starting to fall into place a bit which will make this doable for the foreseeable future from a financial perspective. We are insurance experts at this juncture in our 5 years dealing with cancer. The main issue with insurance/doctors this time around was the delay. We just needed them to tell us what was covered and what wasn't. Until that happened, the doctors hands were somewhat tied per their contract with the carrier. We also couldn't start working on the financing side until we started moving forward with the protocol. The denial is not likely to change - it's legit under the terms of the policy even if it's not legit that it's "medically unnecessary" which is the term they use. We've done the peer to peer, first round appeal and second round. We'll also do the last step - the independent review - however that will be denied as well. I just have to do it in case later on we need to sue them at which point we will get screwed over by ERISA most likely anyway.

@KHilgendorf as for out of pocket, if it's not covered then it neither erodes your deductible or out of pocket max, which we typically blow through by the end of the first quarter each year. If it's not covered, it's not covered. When they initially denied everything, we were looking at $40-70K every 29 days (aka Purple Patch Budget). At this point, we have that down probably 90% and I think before this first round is complete we will have that down still further (shooting for Internet Coaching - Limited E-Mail Budget).

Her doctors are continuing to be amazing and helping us navigate everything hand in hand while keeping all their charges/costs to a minimum if not at $0. After all, she is the poster girl for living with late stage cancer - she is alive and relatively well over a year past her best survival estimate at this point. They can't let good advertising like that go without a fight!