Month: November 2016

Denial, Part 3: VICTORY!

Posted on by Beth Caldwell

When last I spoke to you all, my insurance had denied me approval for my combination therapy. Let me take in the way-back machine before I bring you up to date.

Back in June, I attend the American Society of Clinical Oncology Annual Meeting, aka ASCO. While there, I went to the Novartis booth to ask a question about Affinitor, which I was taking at the time. But nobody at the booth could answer my question, because I wasn’t a doctor. This has to do with FDA rules about pharma providing information to patients that might be medical advice, but it was still pretty frustrating that they hadn’t sent anyone who COULD speak to patient advocates. So, I tweeted about it, with a picture of me in front of their booth.

Novartis immediately responded to my tweet asking me to email them so they could talk to me about it. And their director of patient advocacy called me, and apologized that they hadn’t had anyone there who could speak to me about their drug. She said they’d never had a patient advocate come up their booth at ASCO before, so they hadn’t thought to have someone there could answer patient questions. And she assured me that they were rethinking this now that more patient advocates are coming to medical conferences. It was nice that my tweet resulted in such an immediate response.

Fast forward to my struggle to get my drugs…the fabulous patient advocate at Avera, who deserves a Nobel prize of some sort, helped me file for patient assistance through Genentech, maker of Avastin, and Novartis, maker of Mekinist. She filed the paperwork on a Friday, and on Monday I got a call from Genentech. They spoke to me for about 2 minutes confirming basic information about me, and then said “You’re approved. We’ll send the drug to your oncologist’s office.” I was elated to say the least! 

Then came Tuesday evening. I got a text from #bestdocever saying Novartis had turned me down for patient assistance, because we were above their income cap. This is exactly what I had feared would happen. I started tweeting about it and googling similar drugs to see if maybe there was a different drug we could try to get access to. The Hubs and I started talking about getting legally divorced so I’d fall under the income cap. I slept poorly that night.

Wednesday morning I woke up ready to fight, and I began tweeting again and mentioned that I was filing an appeal of Novartis’s denial decision, as did several of my friends and followers. Two hours later, I got a call from that nice director of patient advocacy who had reached out to me in June. She said she saw I was appeal and she was so glad that I was, and that a whole team of people was going to work on my appeal to expedite it, and she wanted me to know that they were going to work hard on it. I reiterated my frustration that if I divorced my husband, I’d qualify under their income caps, and she said that they certainly don’t want to put anyone through that. I thanked them for expediting my appeal and for reaching out. 

But I kept up the tweeting, because clearly it was having an effect. I mentioned that Novartis made $17 BILLION in profits last year. I explained that their drug is $6,000 a month, which is three times our mortgage. I talked about not wanting to divorce the husband I love. I said I wasn’t ready to die.

At 2:30, we sent in my appeal paperwork. And at 3:30, I got the call from Novartis that my appeal had been granted and I was approved to receive Mekinist. I declared victory on Twitter and thanked Novartis for granting me my drugs. It was a fantastic way to start the Thanksgiving weekend.

What have I learned from all this? Well, insurance companies don’t seem to give a shit about horrible things people say about them on social media. They completely ignored everything we tweeted or posted on their Facebook page. But pharma companies DO seem to care about negative publicity. And pointing out the profits they make and the cost of their drugs, and the crazy things that patients have to go through to qualify for support, seems to motivate them to do the right thing.

I plan to use what I’ve learned to help as many patients as I can get access to the drugs they need to keep them alive. If you or someone you know is having trouble getting access to drugs, please contact me. I intend to use my social media platform and my contacts in whatever way I can to help patients get the drugs they need. That includes holding insurance and pharmaceutical companies to account for their actions–for high drug prices, for bureaucratic hassles, for decisions based on profits and not patient lives. In fact, right now my friend Champagne Joy is waging her own campaign to get her combination therapy drugs. Her insurance company, Cigna, which made $2.3 BILLION in profits last year, is refusing to cover her drugs. You can help her out by tweeting about it, using the hashtag #SaveChampagne.

This battle has been won, but there are more battles to be fought, and I won’t stop fighting until all patients can access the drugs that they need.

Denial, Part 2

Posted on by Beth Caldwell

If you’ve been following me on Twitter, then you’ll know already that the Blue Cross Blue Shield Federal Employee Program denied my appeal of their denial of my combination therapy. Again the reason for the denial is that in metastatic breast cancer, these drugs aren’t standard of care, so they consider them “investigational/experimental.”

Here’s where the problem lies: I don’t have regular breast cancer. I have neuroendocrine breast cancer. Neuroendocrine breast cancer is very rare–about 20 reported cases per year in the US–and there is no diagnostic code for it in the insurance billing systems. There is no standard of care for neuroendocrine breast cancer because it’s so rare. Let me say that again, because this is important: there is no standard of care for my rare cancer. Literally every treatment for it is investigational/experimental.

My cancer didn’t respond to any of the standard treatments for regular ER/PR+ breast cancer, not one of them. The only thing it’s responded to is chemo and even then, it’s been hit and miss. Now we have genomic testing that shows that I have genetic mutations (NF1, BRAF, MET) that have drugs to match them, drugs that have a chance of effectively targeting my cancer and keeping it from killing me so quickly.

But because my rare cancer doesn’t have a code in the insurance billing system, because it’s coded as just breast cancer, my insurance company has refused to pay for the drugs, calling them investigational/experimental and not standard of care. Which is exactly what every other treatment for my cancer is: investigational/experimental and not standard of care.

So basically, my claim has been murdered by bureaucratic crap. The only thing I can do at this point is appeal to the US Office of Personnel Management (because it’s a federal employee plan) and ask them to overturn the denial. This would require a hearing, which means I’d need a lawyer. And in the meantime, I still don’t have the drugs.

This brings us to our current efforts to get me these drugs: applying for patient support programs with the drug manufacturers, Novartis and Genentech. The patient advocate at Avera Cancer Institute has helped me apply for both. Now, Genentech (maker of Avastin) has a pretty good program and we’re hoping to qualify under their income cap after they consider things like child care costs and medical expenses. Novartis (maker of Mekinist) has a lower income cap than Genentech and I’m not sure I’ll qualify without divorcing the husband I love so that I become, on paper, a single mom of two kids living on my disability pension and SSI. 

On top of the obvious emotional nature of getting a divorce when you’re happily married just to try to stay alive, a divorce would cause financial upheaval for us–my husband is currently on my insurance plan, so he would have to get new insurance through his workplace, whose plans aren’t as good as mine, and this would be an added cost for our family. In addition, his survivor benefits upon my death will be impacted unless we carefully word our divorce decree. Again, we’d need a lawyer to handle all this for us, which is another cost. And a divorce takes time; you can’t just go to court tomorrow and walk out of there divorced. Time is not something that I can waste.

So, if Novartis doesn’t approve us under the program, we’re also considering buying drugs in Canada. I haven’t researched any of this yet but old folks have been doing it for years, so why not me? We’re only 2 hours from the border. Or, maybe we do a GoFundMe, because in 2016 that’s how we’re all financing our healthcare apparently.

There’s a question that needs asking: why are these drugs so expensive? Genentech’s parent company, Roche, had a net income of about $9 billion last year. Novartis’s net income in 2015 was $17 billion, up $7 billion over over its 2014 figures. Meanwhile, patients are dying because they can’t access these companies’ drugs without bankrupting their families. Or divorcing the husband they love.

As I’ve said, I’m still hopeful that Genentech and Novartis will come through for us without putting us through a divorce we don’t want. And above all, I want to express how grateful to everyone, from the folks messaging me and tweeting at me with words of support, to the amazing patient advocate at Avera, to my team of doctors. All of this effort to try to save my life leaves me speechless. There aren’t words to describe what you all mean to me.

I promise to keep you all posted about how everything goes down. I’m hoping to have a quick response from Novartis and Genentech and I’ll be sure to let you know when I hear from them. Until then, keep tweeting encouraging notes to both companies, using the #SaveBeth hashtag. We need them on my side right now. Be kind to them, and hopefully they’ll be kind to me!

Denial

Posted on by Beth Caldwell

My insurance company, the federal employee Blue Cross Blue Shielf plan aka FEP Blue, denied the drugs for my combination therapy. They’ll pay for doxil without even a preauthorization necessary, but they denied authorization for both of the immunotherapy drugs. We went with Avastin over the cabozatinib hoping they’d approve it, but they didn’t. 

So, now we appeal. It took a week for FEP Blue to send me the denial letter for the trametinib, and because it’s an oral drug, I have to be the one to file the appeal, so we couldn’t get started on that process until this week. The Avastin appeal has to be filed by #bestdocever and he didn’t get the denial until this week either. Because it’s not like it’s important to get this information quickly when the patient has terminal cancer.

I’m very grateful to have the team at Avera in my corner right now. Their patient advocate has written tons of these appeal letters, so she’s helping out with the appeal process. She’s also appling to Genentech (maker of Avastin) and Novartis (maker of trametinib) on my behalf to seek support via their patient assistance programs. I’m hopeful we’ll be able to get them to help without me going through the charade of legally divorcing my husband so I fit under their income caps.

Here’s the thing. When I look at the data on this treatment approach, and I see that the 30% of patients who couldn’t get combination therapy are all dead, and that 93% of the patients who got combination therapy are alive? Yeah, I don’t just see numbers. I see people. I see my friends. I see Michelle and Jill and Holley and Carolyn and Sarita and Adrian and Ishuan and Jean and Vickie and Jody and Maria and and and…and I think “What if they lived long enough for combination therapy? Would they be alive right now?”

I’m not gonna lie, I’m pretty depressed right now. I’m putting on a brave face most of the time, but it’s not fatigue keeping me in bed right now. It’s a sense that I’m fighting an uphill battle to stay alive. And I can’t help thinking, if it’s this hard for me, an attorney who knows how to navigate systems and has the ability to demand the best treatments, what hope is there for the broader cancer community to stay alive? What hope is there for my friends who are too sick to fight their insurance companies? 

When healthcare decisions are made based on costs and not on saving lives, this is the outcome. We see it happening all over the world, not just here in the US–talk to anyone in the UK about how NICE has made it impossible for them to get access to the cutting edge drugs that are standard of care in the US. But here the disparities between rich and poor, between savvy and unsavvy consumers, feel particularly cruel and despicable. It especially hurts when you realize that the annual cost of my drugs is about the same as one day of pay for an insurance company CEO. 

Does all this make you angry? Does it make you want to help? Good. It SHOULD make you angry. It SHOULD make you want to help. Here’s what I need from you. I want you to share this blog post around social media. Post it on the FEP Blue Facebook page. Tweet it at @fepblue on Twitter. And use the hashtag #SaveBeth. 

Tell them what you think of their decision to deny me the combination therapy that could keep me alive long enough to see The Boy start middle school. Tell them what you think of their business model that puts profits ahead of patient lives. Tell them that I’m not ready to die. Tell them that I deserve to live. Beg them for my life. 

URGENT ALL CAPS ACTION ALERT

Posted on by Beth Caldwell

You guys, we have work to do, TODAY. I need you all to call your Congressional Representative’s office, and tell the person who answers the phone this:

“I am calling to ask the Representative to sign onto the bipartisan Dear Colleague Letter to the National Cancer Institute regarding metastatic cancer research, sponsored by Rep. Peter King and Rep. Chris Van Hollen. It is imperative that we get more Congressional representatives to sign this letter immediately in order to save the lives of the 540,000 Americans who die each year of metastatic cancers.”

Don’t know who your representative is? No problem. Just call 202-224-3121 and they’ll put you through to the right office.

We need to get as many signatures as possible on that letter to ensure the letter has the maximum impact, and we need them in the next 36 hours. Don’t wait–CALL TODAY.