Further research indicates...

...some interesting things.

 

First thing today, I called the medical oncologist's office and arranged to be called back with answers to some of my questions. Then I called FEPBlue, the federal Blue Cross people.

 

And the Customer Service person there told me that if I got the syringes sent to me by their email service, the cost would be only $70 for up to 90 days worth. I only need 60 days, but apparently it would be about the same. The nice lady gave me two numbers to call; one for the pre-authorization, and one for the "Special" pharmacy.

 

!

 

Then the doctor's office called back, and I found out that if I drive into Dana-Farber the day after my chemo treatment, the Wonder Drug (neulasta, if you're wondering) would cost me....

 

Are you ready for this?

 

$0.00

 

Y'see, if I get it at Dana-Farber, it can be billed as part of my "chemo footprint".

 

A few hours later, I got another call from the doctor's office -- the pre-authorization had been submitted, but I needed to call the "Special" pharmacy to find out my co-pay. So I did. And... my copay is not $1,961, and it's not $70.00.

 

My co-pay is $0.00. Because this is a catastrophic illness, and I have already used up my catastrophic deductible for the year. Apparently, this information was not available to the insurance people who gave the original co-pay quote to my health plan's pharmacy, because it came through the regular approval process, not through the "Special" pharmacy that's part of the mail order pharmacy.

 

Are you following this, Gentle Readers? To summarize:

• If I was to buy this drug outright, two syringes would cost me between six and seven thousand dollars.
• If I had shrugged my shoulders and accepted what my health plan's pharmacy was told by the right hand of my insurer, I would have paid $1,691.00.
• If I had gone with the first information from my insurer's left hand (whose activities clearly are not well monitored by the right hand) when I called them, I would have paid $70.00.
• If I had gone with the information from Dana-Farber, I would have paid $0.00, but might well have shelled out $100.00 in cab fair there and back if I'm not well enough to drive.
• As it is, it seems (and that caveat is there because at this point I am so confused that I am fully prepared to be told I have to pay my weight in diamonds) that I will be paying $0.00 to have the drug mailed to my home, where I will take it on a very short cab ride to Medford, MA and pay $20.00 to have one of my health plan's nurses inject it.

 Let's see... I make that three different sets of information from the same insurer. And while I am pleased to be paying $0.00 (assuming that's what ends up happening), I am appalled as to what this means with regard to the effort to reduce health care costs by making people better consumers of health care. I mean, WTF, Blue Cross?

In related news, it seems that the speeded-up schedule for chemo DOES have a medical purpose. There are fewer metastases and recurrences when the schedule is accelerated. So it's not just for my convenience and to allow me to attend Thanksgiving dinner with the chemo all behind me. :)

I would also like to point out that when I was given the recurrence/metastaes stats by the Dana-Farber staff, they told me both the initial risk (what could happen if I did nothing) and the absolute risk (what could happen if I did the treatment). They did not tell me the relative risk, which is that the chemo reduces the chance of recurrence / metastases by 50%. Which sounds like a lot, until you realize that you're starting from 15%. Relative risk is how drug companies sell, and by not putting a lot of emphasis on relative risk the Dana-Farber doctors appear to be fighting the Boobeaucracy from within!