Wednesday, June 15, 2011

The big donut hole

Dr. Porubcin saw mom today and reviewed her blood work. Overall, things were ok, and her CA125 was down in the 600's. That's is an improvement so we'll take that and be happy about it. Her feet have been ok in the last week (less peeling, stinging) and haven't been giving her as many problems. That said, Dr. Porubcin felt that she could continue with about 3 or 4 more Doxil treatments spaced at 5 weeks apart. Trinity was able to schedule her in tomorrow at 1:00 p.m. - so we're going to chemo tomorrow. I'm glad as that will mean less of a gap between treatments...losing any ground at this point would be a bad thing. 

Doctor was concerned about her iron level, so she has go to in for some iron infusions through IV for the next few weeks. She could take the iron orally, but given her stomach issues with the Doxil, IV would be better. It's kind of a hassle, as the treatment takes 2 hours through the IV so that means that she has to go to Trinity every other week. But if the IV is easier with less side effects (you don't want to know... she and Dr. P. were talking about "stool effects" of oral iron tablets when I started to gag) and also more comfortable on her stomach, I think IV is better. She can drive herself to treatments and then maybe we can go out to lunch or something afterward. Not a bad deal IMO.

RE: The Big Donut Hole. I have only learned of this concept in the last week. It's a popular phrase in the health insurance world, and it relates to supplemental insurance that one has to get when other supplemental insurance for prescriptions runs out. Normally, people don't run out of prescription coverage, however not everyone spends $2,300+ a month on prescriptions like mom. The Lovenox is the most expensive drug she needs (to keep her blood clottage in check) and she pays a minimal co pay, but the insurance company is paying the rest of the thousands of dollars. Of course the insurance company doesn't like that [paying], so they told mom that she is getting close to running out of the coverage. She has been on the Lovenox for the last two years (going on three) so literally if we take $2,300 x 24 mos = $55,000 has been spent on Lovenox by the insurance company. 

The current insurance company told mom that when she has reached the $5,000 balance point, they will let her know so she can find a different company with supplemental insurance for prescriptions. There is a plan available through Blue Cross/Blue Shield, and mom has talked with them a couple of times. She can apply over the phone and get it taken care of pretty quickly. There is a premium, but that's how insurance works. 

BUT that is not the crazy part... Blue Cross/Blue Shield says that her prescriptions are covered with a co-pay ($9) up to $2,800. Then, this thing they call a "donut hole" takes effect, which means that she will have to pay OUT OF POCKET for prescriptions until she gets to the $4,800 mark. Then, after the $4,800 mark she will return to pay either a co-pay or minimal percentage of the prescription. I am going to find out who came up with this donut hole concept and write them a letter. I'm sure it makes sense to them but it really isn't fair to people who really need prescriptions like the Lovenox.

Sherri at Dr. Porubcin's office has information on a couple of foundations that help with prescriptions when they hit the donut hole phase. The good thing is that she has time (at least a couple of months) to get things in order. 

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