The pains with the American system

Having decent insurance has made most of the process of cancer treatment go smoothly. You’d have thought with a week of advance notice, it would all be figured out … but not so much.

The chemo went well today – well seems like an odd word to use w.r.t chemo – it went, I’m feeling a little stressed (just took something for that). Don’t think I’m feeling any nausea, but I’m not sure if worrying about nausea is causing nausea or if I’m actually feeling nausea .. so we will wait until the anti-anxiety meds kick in and then decide if I need / want another anti-nausea pill. I have several options, so all is good.

Talked to the oncologist about medical marijuana. The oncologist didn’t see any problem with it, but he couldn’t write the prescription (against Stanford policy). He did warn us of dosage issues – in that you often cannot accurately measure the dosage (very dependent on where you get it). Nor can my family doc – although my family doc suggested I see one of the various “pain” docs who do write the prescriptions. It is a bit of a game, but we have followed the rules so far. Next step is to find someone to write the prescription. Some of the docs that write the prescription also issue “cards” which is all you need to purchase marijuana at one of the many local dispensaries (indicated by a green cross) – however, there is also an official card that one can get from Santa Clara county for $150 after the doctors note. Some dispensaries/collective actually test the stuff to make sure they label the dosage correctly – others, not so much. Honestly, right now we are just setting things in motion, so that if it becomes needed it is an option. I’m worried about the side effects of the anti-anxiety drugs (they can be habit forming) – so alternatives might make more sense. We’ll see.

On the other side of things, I’m supposed to get a neulasta shot tomorrow – which is used to boost the white blood cell count. My insurance company won’t approve me going to Stanford for the shot – rather, I’m supposed to do it myself. It is a subcutaneous (in between skin and fat) injection, which is similar to how one gives insulin, so Scott is rather familiar with the process. My chemo nurse at Stanford gave us a lesson on how to do it. It is actually going to be more convenient for us this way, as it means that Scott can give it to me after work, rather than having to take more time off to drive up to Stanford for a simple needle.

The problem is getting the actual medication. Stanford put the order into my pharmacy but the insurance wouldn’t go through (the neulasta shots are about $4000 each). So they called Stanford who tried to get it approved, only to be told that we needed to make the request (so it couldn’t be made on behalf of us), we called, to be told that there is no pre-authorization, so Stanford needs to call to do the pre-authorization (and get an urgent pre-auth done). Once we hear that the pre-auth is done, Scott needs to call back Express Scripts and have a supervisor do an override (which may also need insurance authorization). Once we get the override, then our local pharmacy can fill the prescription. However, this all needs to happen before 8pm tonight as the pharmacy doesn’t stock neulasta, so they need to order it today so that it arrives by mid-day tomorrow.

If we don’t get the insurance approval until tomorrow, we will need to find a pharmacy that actually stocks neulasta (either Stanford or hopefully one at the Palo Alto Medical Foundation, as they are closer).

One way or another it will happen … just a lot more drama than I would have liked. Not sure why this pre-auth requirement didn’t surface sooner as they have known for over a week that I was starting chemo today. But, as the saying goes, ‘it is what it is’ … we shall deal with it.

  • Becky

One Comment

  • Fortunately it all worked out in the end. The Stanford team made the required phone calls to initiate the urgent pre-auth, and we got a phone call from the pharmacy that they’d tried again and the prescription was approved. Much easier than we’d expected – insurance had told Stanford that the urgent pre-auth could still take 24 hours, then we would still need to call to get the prescription filled locally.

    Lesson learned – pre-auth for treatment and pre-auth for drugs are handled by different insurers, and may require different pre-authorizations.

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