No sooner did I pack up my things at work today, than my cell phone rang. I wasn’t surprised to see it was Dr. Brook’s office at first since I thought I had an appointment tomorrow and it was calling to remind me. It wasn’t until I started talking to the woman that helps with the insurance and billing there that I realized my appointment is next week. The last time I spoke with Wanda and Bonnie, they were trying to get my Lupron approved. This time, they’re trying to get my irinotecan past the insurance.
Why? Apparently irinotecan is normally used in colon and rectal cancer. Mine is neither of those. It is, however, sometimes used in other cancers off-label. Insurance doesn’t like the term “off-label.” Worse than that, they usually refuse to pay for off label.
On a drug that you take rarely or even a daily drug that doesn’t cost a fortune, this wouldn’t be as much of a problem. With chemotherapy agents, they cost thousands of dollars most of the time. My Gemzar and cisplatin was marketed at seven thousand dollars, most of which was written off when my insurance offered them a mere thousand dollars towards the bill. I’m not sure what this drug costs, but I can’t imagine it is cheap. Wanda said that if the insurance doesn’t pay for it, there is still one other method we can try. Sometimes, they use the drug anyway and the company will send them more of it for free in special cases. For that, however, we’d have to qualify financially. I’m really nervous that we won’t qualify since I make so much money as a nurse. When I looked into financial assistance for the cost of the Lupron, I made too much money to qualify for anything. I’m pretty worried that this will be the same thing.
I’m not sure what the options are if the financial assistance or insurance doesn’t work. If the insurance company does deny the treatment, I feel like they are saying “I’m sorry the first line drug didn’t work, but you should go ahead and die since we don’t want to experiment with something that might.” I’m so damn frustrated with how things progress sometimes. Just when we have something that could work, we’re thrown a curve ball. How is that fair? How much more am I expected to deal with before we just take care of me and my disease?