Maintenance Therapy

As I mentioned in a previous posting, I will be starting maintenance chemotherapy soon. This drug - Revlimid - will help me to remain in remission longer. I have not started yet as the approval process is just commencing.

Approval process?? What is that? Are we, as Canadians, not entitled to medications and medical protocols that will help us when we are ill?

It may surprise you that cancer medication is no different than obtaining antibiotics when you have pneumonia. If you went to your doctor and were diagnosed with pneumonia, you would be given a prescription for antibiotics and you would head over to the pharmacy to fill it. If you were self-employed and had no medical plan, you would be expected to pay out-of-pocket for that medication. If you have a medical plan, you would pay 20% or a similar amount and your insurance company would cover the rest. The exception is for intervenous drugs that are administered in the hospital or by a health care professional in a home care environment. Many chemo drugs are now administered in pill form, and they have to be picked up by the patient at the pharmacy.

Revlimid for chemo maintenance therapy costs $8000.00 per month. The drug company has a compassionate program whereby they will fund some or all of the cost depending on your circumstances. They also screen to ensure you are a good candidate for their drug. They will conduct a telephone interview with me this week to determine if I am a suitable candidate. I am not sure what they will ask, but assume it will be related to my age, overall medical condition, whether I am of child-bearing age and considering having children, etc. I expect to have no difficulty in obtaining approval.

Once I have approval for the drug, the manufacturer will negotiate with my medical plan provider to determine if they will cover the drug, and at what percentage. Since maintenance chemo is not required for my treatment, but is an accepted protocol to extend remission, they may have an out. We expect them to cover it at 80%. We are also hopeful that the drug manufacturer will pick up the tab on the other 20%. If they do not, my medical plan has a catastrophic clause that I will only be out of pocket $3000 per year and 100% of the remainder will be covered. Phew! Fingers crossed!

Once I get approval, and start taking it, I will likely feel fatigued again and may become neutropenic. This means that my antibodies could become low and I will be unable to fight infection effectively. If this happens, I will have to be careful of public interactions again. :(

As I learn more, I will update my blog.