Cycle 7: Dodging Life Pot Holes

I know it's only been about 6 days since my last blog but I'm feeling generous with my blogging (or maybe it's the steroids talking 🤣).

Dodging the pot holes of life.....

So there was a bit of an unexpected hiccup on the eve of Cycle 7.  I received a few calls yesterday regarding one of the medications that I receive - the Neulasta Onpro On-Body Injector (aka OBI).  For all my non-pharm friends and family, this is a cool device that contains the medication that helps my blood counts recover and prevents me from being susceptible to infections.  The medicine is filled into a square injector that is then placed on my body.  About 27 hours later I receive the injection.  Basically it allows cancer patient the freedom of not having to return to the chemo clinic the following day just to receive an injection.  And in order to continue on the Taxol/Carbo part of my chemo regimen I must have this medication.  The first call I received was from Express Scripts, the pharmacy benefits manager (PBM) for OSU.  The call was automated and didn't give me any real information, only saying that they had denied a prior authorization (PA).  PAs are basically a way that the PBM tries to control what medications you can obtain.  Your provider must fill out paperwork and explain why you need a certain medication before they will cover it.  Before I had a chance to call them back, I received a call from the OSU Outpatient Pharmacy (OP) Manager, who explained to me that the OBI would no longer be processed through my medical insurance and now would be processed though my prescription plan, shedding light to the mysterious Express Scripts robo call I received earlier.  Just to give you all some context - for the previous 5 chemo cycles the OBI had been covered by my medical plan with all the other pre-medications and chemo meds and had always been placed by the nurse when my chemo was finished.  However, with this new change I would need to get the OBI filled and dispensed through the OSU Outpatient Pharmacy.  This change created some life pot holes.

Life Pot Hole #1:  what's this gonna cost me (aka paying the copay).  The first thought I had was - "yikes, how much is this going to cost??"  As a pharmacist I know that the OBI is not cheap.  I can't share with you the actual wholesale price but just know that you could take a nice transatlantic cruise for the cost of just one injection.  But before I get side tracked discussing awesome potential transatlantic cruises lets get back to the story at hand.  After some calls made by the OSU OP staff, they were able to get my prescription plan to pay for it but my co-pay would be about $150!!  YIKES - that's way better than the full "transatlantic cruise" price but still not what I was hoping for.  Luckily, the drug company that makes the OBI has assistance cards for patients that are not currently on Medicare or Medicaid.  So the OP staff sign me up for the program and just like that the first copay dropped to $0 and future copays dropped to $25!!  PUBLIC SERVICE ANNOUNCEMENT for my non-pharm friends and family: always, always, always, ask your pharmacy if there is an assistance program for these very expensive medications.  Most have them and they can be really beneficial!!  Shout out to the AWESOME OP staff at the James - YOU GUYS ROCK!!

Hurdle #2: who's going to place the OBI??  So like I mentioned before, for the previous cycles the nurse would get the OBI from the pharmacy clinic, just like all the other medications and place the OBI when my chemo was finished.  It was all so easy, peasy, lemon squeezy.  Now the OBI would be dispensed by the OP so that threw a wrench in things.  In discussing my options with the manager, he said that I could do one of two things:  #1 they could dispense it and have one of the delivery drivers bring the OBI over to the chemo clinic at which I receive my chemo or #2 after I finished chemo I could come over the OP and have one of the OP place the OBI (which was a fairly new process for them).  Me being me, opted to contribute to the learning of others and decided to go with option #2.  I believe that practice makes perfect and that if anyone is the perfect patient to practice this on - it would be me!  And with all that they had done to help me with the copay I felt it was the least I could do.  Chemo finished in the early afternoon and Nathan drove me over the James main campus.  I ended up being the first patient for one of the OP and everything went smoothly.

In all seriousness, I cannot thank the Outpatient Pharmacy group enough!!  They are always so helpful when issues arise and are AWESOME to work with!!  Also, I would be amiss if I didn't knowledge how lucky I truly am. I have access to healthcare and have so many people supporting me during this fight!!  There are others in this world (both near and far) that do not have these luxuries!!

Ta-ta for now.  PS - Nathan describes these sessions when I am really talkative and energetic as me "roiding out".  #blameitontheSTEROIDS