PILLS AND BILLS

I got a call early Wednesday morning from Tonisha of Dr. Tan’s office apologizing for not getting back to me yesterday. She said that she was filling in for another person in another part of the office. It left her post unstaffed. She said that everything is in order for Novartis Pharmaceutical Company to consider helping us out, except they need to do the insurance coverage verification. She expects to hear from them this afternoon (Wednesday). Well, that is also my deadline for ordering before the weekend. I have enough Gleevec to last until Saturday. To get Gleevec by then I must order today (Wednesday).

Even if we get help, that doesn’t silence my words about others who are in similar or worse scenarios. Have you ever looked at your EOB (Explanation of Benefits)? I looked at ours online this morning. My family doctor charges $217.00 for a simple routine visit. The insurance company approves $72.10. We paid (last year) a co-pay of $25.00. A cash patient, or one with a high deductible, has to pay the full charged amount. The neurologist I saw charged $256.00 for a lengthy examination. The insurance paid $114.76. The co-pay was $50.00. Dr. Tan charges $220.00. The insurance paid him $79.81. I paid a co-pay of $50.00. My lab tests are around $4,000.00 every six months. I paid very little of that but I suppose I’ll be paying more of it this year because of the insurance changes. Finally, there is Gleevec. My insurance company is charged $6,618.53 per thirty day supply. That pushes the cost of Gleevec up to nearly $80,000 per year!! I knew the cost had gone up. Anyway, the insurance company pays $5,228.32 per month for my Gleevec. Well, they did or use to!! It’s expensive to live and even more expensive to try to keep from dying.

UPDATE:

It’s a little past 11:00 Wednesday morning and I received another call from Tonisha of Dr. Tan’s office. She said that Novartis is referring my case to another department in their company. She said they will call me today and may give me a supply of Gleevec until they decide my case. I’ll just have to wait and see.

UPDATE II:

It’s now 3:30 in the afternoon. I still have no call from Novartis. I called Tonisha again and left a voice mail that I hadn’t heard from Novartis. I need Novartis to tell me if they are going to give me a supply or not, so I can order if they aren’t. I don’t want to order if they will because it will cost $5,253.22 for thirty pills. I’m not supposed to skip a single dose but for that kind of money I might have to miss a day or two. I wonder if Tonisha is gone for the day.

UPDATE III:

Tonisha called me back at 4:15 pm. She was surprised that Novartis hadn’t called me and said she would call them and call me back. She did. She said the lady at Novartis forgot to hit the “processed” button so it didn’t notify the next person to call me for delivery confirmation. She said the earliest they will be able to get me Gleevec is on Tuesday. That leaves me two days without Gleevec. Tonisha said she’ll call the local Novartis representative before she leaves the office and see if she can get me a couple of Gleevec pills to hold me over. I hope she can get it done.