When I entered the family room, I nodded my head and raised my hand with anticipation of praise as I announced, "Thank you, thank you! I trimmed my own toenails." My dad smiled wide with pride and told me to get a sticker for my sticker book. Being an adult is hard.
In regards to my health, I don't feel qualified to make treatment decisions. The doctor tells me a list of options and then tells me to choose. In the moment, I may think I made a solid decision. However, after pondering my selection, I wonder what the hell I'm doing? When did a biological medicine being infused into my vein become the best choice? According to my nurse advocate, my insurance approved Remicade, but my co-pay is really high (she didn't tell me the amount of the co-pay). She will be mailing me paperwork for Remistart, which is a patient rebate program to help with co-pays. Eligible patients only pay $5.00 per infusion. I went ahead and scheduled my loading doses for May 3rd, May 17th, and June 14th. After the loading doses, infusions will be scheduled every eight weeks. The bad news is that the infusions take two and half to three hours and my nurse advocate only administers infusions Tuesday mornings or Friday mornings at her office in Ocoee, which is nowhere close to Sanford where I work. That means more time I have to "waste" taking off of work for my health. I'm going to be lucky if I have enough time off left in November for the NYC marathon. Anyways, when I made the appointments, I didn't know where Ocoee was located. I'm going to call her tomorrow to see if I can request a location closer to Sanford. Either way, I'm going to have to talk to my supervisor to let her know I'll be needing more time off. Hopefully, she'll still be understanding. If I do keep my Remicade infusion appointment on May 3rd, I will not have to do any more Cimzia injections.
My colorectal specialist told me to take two weeks to recover from what ended up not being as serious as we thought going into it. Technically, I should probably wait until my follow up appointment on the 29th or call her office to get approval to start exercising again. But you know me, I do what I want. I walked two miles on Monday to prove to concerned family members I really am ready to get moving again. On Tuesday, I ran one mile with my sister, Kelly, and then we walked another two miles. It felt good. I'm a little sore, but I'm excited to start training again.
My company is hosting a picnic for Employee Appreciation at SeaWorld this Saturday. I was allowed to RSVP for myself and one guest, so Taylor is coming into town to be my guest. After the picnic at Sea Harbor Pavilion, my company paid for everyone's ticket into the park. Bonus: For only $20 I can update the ticket to a fun card for the rest of the year! They've already distributed the free parking ticket. I'm excited because I haven't been to SeaWorld in forever!
Showing posts with label cimzia. Show all posts
Showing posts with label cimzia. Show all posts
Wednesday, April 20, 2016
Friday, April 15, 2016
An Update
It hasn't even been a week and I'm already getting antsy. I'm restless mostly because the New York City Marathon is on my mind. Don't get me wrong, I'm thrilled I'll be back pounding my feet against the pavement sooner than originally planned. However, it's still frustrating to wait it out because my hopes are high. I've been on Pinterest looking at a bunch of workout motivation. It inspired me to incorporate some cross training in with my marathon training once I start training again. I'm excited to feel my body get stronger and my mentality get tougher throughout the next few months.
I went to see my gastro yesterday to talk about medication options. It's a little scary knowing that there aren't a lot of effective treatment options available. The two options my doc recommended were to add 6MP to my treatment while continuing with Cimzia or stopping Cimzia and switching to Remicade.
I was on 6MP for years after I was first diagnosed with Crohn's. Now, looking back I wonder if my parents even knew what 6MP is. I certainly didn't know or care at the time. It's actually a chemo therapy drug. Anti-cancer drugs are pretty common in Crohn's treatment, but I think it's a little harsh. It's really bad for the liver and frequent lab tests need to be done to monitor its affect on the kidneys and liver. There is also a higher risk of lymphoma when taking Cimzia with 6MP than other options. Isn't that ironic? My first treatment strategy was to exhaust all of my options with Cimzia before stopping it. Once you stop a biologic like Cimzia, you can't go back on it because your body will build antibodies against it and reject it. I just don't think it makes sense to keep moving forward with Cimzia because it hasn't been very effective for a while now. Most of the medication options are frightening, but 6MP is a little scarier than other options in my opinion.
That leaves me with Remicade, which is an infusion I can't administer myself. I'm told this is a more potent treatment for Crohn's and most patients see better results with it than with Cimzia. Remicade is a TNF blocker like Cimzia with similar risks. It's way more expensive than Cimzia, so I'm in the process of figuring out if my insurance will cover it before I can make the switch. Thankfully, I have a nurse advocate helping me figure it all out. I'm surprisingly excited at the possibility of bidding Cimzia farewell.
In other news, Ticketmaster finally released my tickets to Halsey on July 6th at the CFE Arena! I'm super stoked about that.
I went to see my gastro yesterday to talk about medication options. It's a little scary knowing that there aren't a lot of effective treatment options available. The two options my doc recommended were to add 6MP to my treatment while continuing with Cimzia or stopping Cimzia and switching to Remicade.
I was on 6MP for years after I was first diagnosed with Crohn's. Now, looking back I wonder if my parents even knew what 6MP is. I certainly didn't know or care at the time. It's actually a chemo therapy drug. Anti-cancer drugs are pretty common in Crohn's treatment, but I think it's a little harsh. It's really bad for the liver and frequent lab tests need to be done to monitor its affect on the kidneys and liver. There is also a higher risk of lymphoma when taking Cimzia with 6MP than other options. Isn't that ironic? My first treatment strategy was to exhaust all of my options with Cimzia before stopping it. Once you stop a biologic like Cimzia, you can't go back on it because your body will build antibodies against it and reject it. I just don't think it makes sense to keep moving forward with Cimzia because it hasn't been very effective for a while now. Most of the medication options are frightening, but 6MP is a little scarier than other options in my opinion.
That leaves me with Remicade, which is an infusion I can't administer myself. I'm told this is a more potent treatment for Crohn's and most patients see better results with it than with Cimzia. Remicade is a TNF blocker like Cimzia with similar risks. It's way more expensive than Cimzia, so I'm in the process of figuring out if my insurance will cover it before I can make the switch. Thankfully, I have a nurse advocate helping me figure it all out. I'm surprisingly excited at the possibility of bidding Cimzia farewell.
In other news, Ticketmaster finally released my tickets to Halsey on July 6th at the CFE Arena! I'm super stoked about that.
Saturday, March 5, 2016
Big Week Next Week
Why does it seem like everything in life happens all at once. Next week is big because I'll be hearing back about the job either way, the lottery drawing for the NYC marathon is on Tuesday, and I should be getting my lab results back and hopefully feedback from my doctor about whether I'll be staying on Cimzia or not.
I interviewed for the contracts/risk specialist position on Thursday. There were two interviewers in the room and another interviewer on a video conference call. It was a little intense to be on the video screen during the interview. Questions flew at me in all directions. One right after the other for 45 minutes. At one point, I thought that interviews should be called interrogations instead. I never trust my vibes about things like this, so time will tell how it went. I can say that I'm pretty happy the way I answered the questions and I think my closing questions were solid. One of my questions was, "Do you see any gaps in my qualifications that would prevent you from offering me the position?" If offered the position, they know I would be transferring from a different department, so I told them that we would have to discuss the time frame with my supervisor to make a smooth transition. I'll find out next week if I got it or not. I really want to get this job offer. Either way it turns out, at least, I know I did my best.
I am pretty much freaking out about the lottery drawing on Tuesday!!!!! I want to get in so badly even though I am so out of shape that I have trouble running two straight miles without walking. I know there's only like an 18% chance that I'll get in, but I'm totally getting my hopes up about it.
I just got home from getting lab work done, finally. After three weeks, I felt healthy enough for it. The nurse struck gold on the first try, which is super rare. Plus, she didn't even have to move the needle around inside me to find the vein. She hit it right away. My arm doesn't even hurt. I hope to get the results back next week with feedback from my doctor. These labs are supposed to tell us if I'm still anemic and if Cimzia is still working. I stopped taking iron again last week and my period started yesterday, so I'm not very optimistic about my iron levels; However, I am optimistic about whether Cimzia is working or not. I have not been having any pain and my poop has been pretty good lately.
I interviewed for the contracts/risk specialist position on Thursday. There were two interviewers in the room and another interviewer on a video conference call. It was a little intense to be on the video screen during the interview. Questions flew at me in all directions. One right after the other for 45 minutes. At one point, I thought that interviews should be called interrogations instead. I never trust my vibes about things like this, so time will tell how it went. I can say that I'm pretty happy the way I answered the questions and I think my closing questions were solid. One of my questions was, "Do you see any gaps in my qualifications that would prevent you from offering me the position?" If offered the position, they know I would be transferring from a different department, so I told them that we would have to discuss the time frame with my supervisor to make a smooth transition. I'll find out next week if I got it or not. I really want to get this job offer. Either way it turns out, at least, I know I did my best.
I am pretty much freaking out about the lottery drawing on Tuesday!!!!! I want to get in so badly even though I am so out of shape that I have trouble running two straight miles without walking. I know there's only like an 18% chance that I'll get in, but I'm totally getting my hopes up about it.
I just got home from getting lab work done, finally. After three weeks, I felt healthy enough for it. The nurse struck gold on the first try, which is super rare. Plus, she didn't even have to move the needle around inside me to find the vein. She hit it right away. My arm doesn't even hurt. I hope to get the results back next week with feedback from my doctor. These labs are supposed to tell us if I'm still anemic and if Cimzia is still working. I stopped taking iron again last week and my period started yesterday, so I'm not very optimistic about my iron levels; However, I am optimistic about whether Cimzia is working or not. I have not been having any pain and my poop has been pretty good lately.
Thursday, January 28, 2016
My Birthday Wish
Update: I finally got Cimzia approved through my insurance... again! Go me!!!
"How are you?" When that question is directed at me, it has got to be the most confusing question that exists in the English language. Family, friends, doctors, nurses, counselors, and co-workers alike inquire about my well being. All at different levels, of course. Nonetheless, it's up to me to figure out how I am, which is tricky.
How am I? Would "I don't know" be an acceptable answer without leading to more inquisitive questioning? How am I compared to what exactly? My "normal" seems to constantly be fluctuating. Most days, I'm not sure if my body is telling me the truth or if I am perhaps misinterpreting it all together. I don't trust my body. How can I? The bloody thing attacks itself. Hell, I was so used to constant pain in my stomach for a while that when I burned my hand pulling something out the oven a few weeks ago it didn't even hurt. It felt like a light pinch that went away quickly, but the blistering skin on my palm told another story. Burning your hand should hurt, right? I just figured the pain the burn caused must have been minimal compared to the other pain I had been experiencing, so my body didn't have a big reaction to it.
How am I? In this very moment, I'm convinced that I'm doing better. What exactly am I doing better than? I think I'm doing better than I was doing over the past three months or so because I have more energy, my bowels have been somewhat okay (there's always room for improvement, but isn't that case with most things in life?), I haven't felt pain in about two weeks, and I actually want to hang out with people. I even went for a run this week and it was beyond amazing. Sure, I'm totally out of shape and I was breathing heavy, but I didn't struggle to breath like I did during my last attempts that made me swear off running for a while. Last month I was certain Cimzia stopped working, but now I'm unsure what to think. I'm supposed to be getting lab work done in February that will tell me how I really am.
How am I? I'm pretty sure I'm still anemic because I stopped taking iron pills. I can't wait for my dr. to lecture me about that. I just couldn't handle being constipated all the time. I'm pretty sure my stricture is still super tight even though I'm hopeful my appointment with my colorectal on February 12th goes better than the last time I saw her. It's to the point where I'm actually wishing the scope for the sigmoidoscopy will fit past my stricture so that we can take a look at the disease on the screen. In order for that to happen, my doctor has to be able to get her finger up my ass, which was an agonizing problem last time even with lube. Yeah, so that's my birthday wish... being able to get fingered in the ass. Maybe I need to find a special someone that would finger my ass regularly between visits with my doctor to keep my stricture loose. Doesn't that sound like a good blurb to put on a dating website? I would do it myself, but giving myself enemas is nearly impossible as it is. It's traumatizing and I'd much rather someone else torture me than me having to do the horrific thing myself. I've always said if someone likes it in the ass, that's a sure fire way to tell they don't have Crohn's disease.
Oh, by the way, my sisters say that I must be feeling better because my humor is coming back.
"How are you?" When that question is directed at me, it has got to be the most confusing question that exists in the English language. Family, friends, doctors, nurses, counselors, and co-workers alike inquire about my well being. All at different levels, of course. Nonetheless, it's up to me to figure out how I am, which is tricky.
How am I? Would "I don't know" be an acceptable answer without leading to more inquisitive questioning? How am I compared to what exactly? My "normal" seems to constantly be fluctuating. Most days, I'm not sure if my body is telling me the truth or if I am perhaps misinterpreting it all together. I don't trust my body. How can I? The bloody thing attacks itself. Hell, I was so used to constant pain in my stomach for a while that when I burned my hand pulling something out the oven a few weeks ago it didn't even hurt. It felt like a light pinch that went away quickly, but the blistering skin on my palm told another story. Burning your hand should hurt, right? I just figured the pain the burn caused must have been minimal compared to the other pain I had been experiencing, so my body didn't have a big reaction to it.
How am I? In this very moment, I'm convinced that I'm doing better. What exactly am I doing better than? I think I'm doing better than I was doing over the past three months or so because I have more energy, my bowels have been somewhat okay (there's always room for improvement, but isn't that case with most things in life?), I haven't felt pain in about two weeks, and I actually want to hang out with people. I even went for a run this week and it was beyond amazing. Sure, I'm totally out of shape and I was breathing heavy, but I didn't struggle to breath like I did during my last attempts that made me swear off running for a while. Last month I was certain Cimzia stopped working, but now I'm unsure what to think. I'm supposed to be getting lab work done in February that will tell me how I really am.
How am I? I'm pretty sure I'm still anemic because I stopped taking iron pills. I can't wait for my dr. to lecture me about that. I just couldn't handle being constipated all the time. I'm pretty sure my stricture is still super tight even though I'm hopeful my appointment with my colorectal on February 12th goes better than the last time I saw her. It's to the point where I'm actually wishing the scope for the sigmoidoscopy will fit past my stricture so that we can take a look at the disease on the screen. In order for that to happen, my doctor has to be able to get her finger up my ass, which was an agonizing problem last time even with lube. Yeah, so that's my birthday wish... being able to get fingered in the ass. Maybe I need to find a special someone that would finger my ass regularly between visits with my doctor to keep my stricture loose. Doesn't that sound like a good blurb to put on a dating website? I would do it myself, but giving myself enemas is nearly impossible as it is. It's traumatizing and I'd much rather someone else torture me than me having to do the horrific thing myself. I've always said if someone likes it in the ass, that's a sure fire way to tell they don't have Crohn's disease.
Oh, by the way, my sisters say that I must be feeling better because my humor is coming back.
Saturday, January 23, 2016
Dealing with Insurance... Again
So, when I called OptumRX to refill my prescription on Thursday, the lady told me that insurance denied coverage. After asking a bunch of questions to try to figure out why, she finally told me that my account has Medicare as my primary insurer. Umm, I've never had Medicare in my life. She said I would have to call my insurance and request, "blah, blah, blah," I can't remember what she said my insurance needed to do.
Anyways, I called UHC and I explained that OptumRx is showing my primary coverage as Medicare even though I've never had Medicare. The lady finally figured out that I was somehow switched back to my parents plan, which is also UHC, not Medicare. Thankfully, she knew the "blah, blah, blah," she was supposed to do and told me that it would take 24 hours to take effect on OptumRX systems. She also had no clue how or why I was switched back to my parents' plan.
I waited a day and called OptumRX again. This time I began by reading off my member ID number for my insurance to make sure that's what they had on file for me. It wasn't and it wouldn't let the guy change it manually in the system. He also told me I would need, "blah, blah, blah," and I told him I already had my insurance do "blah, blah, blah." So, he tried to get ahold of the "Resolutions Team." There was a long wait line because all of the call centers on the east coast were sending their calls to the west coast, so I had to wait over two hours for someone on the Resolutions Team to call me back.
Finally a Resolutions Specialist called me back and was able to setup my correct insurance on file. She also didn't know why or how I would have been switched back to my parents' insurance. At least, she was able to process my order and refill my prescription.
All of this prompted me to login to my UHC account to look at my claims. It turns out the last claim my insurance has for Cimzia was back in October. My mom is supposed be looking into seeing if my refills since then went to her claims. It appears I was switched back to my parents' insurance a while ago and it was only brought to my attention now because they denied coverage. Insurance companies are so stupid, but I can't really hate them because they save me so much money.
Anyways, I called UHC and I explained that OptumRx is showing my primary coverage as Medicare even though I've never had Medicare. The lady finally figured out that I was somehow switched back to my parents plan, which is also UHC, not Medicare. Thankfully, she knew the "blah, blah, blah," she was supposed to do and told me that it would take 24 hours to take effect on OptumRX systems. She also had no clue how or why I was switched back to my parents' plan.
I waited a day and called OptumRX again. This time I began by reading off my member ID number for my insurance to make sure that's what they had on file for me. It wasn't and it wouldn't let the guy change it manually in the system. He also told me I would need, "blah, blah, blah," and I told him I already had my insurance do "blah, blah, blah." So, he tried to get ahold of the "Resolutions Team." There was a long wait line because all of the call centers on the east coast were sending their calls to the west coast, so I had to wait over two hours for someone on the Resolutions Team to call me back.
Finally a Resolutions Specialist called me back and was able to setup my correct insurance on file. She also didn't know why or how I would have been switched back to my parents' insurance. At least, she was able to process my order and refill my prescription.
All of this prompted me to login to my UHC account to look at my claims. It turns out the last claim my insurance has for Cimzia was back in October. My mom is supposed be looking into seeing if my refills since then went to her claims. It appears I was switched back to my parents' insurance a while ago and it was only brought to my attention now because they denied coverage. Insurance companies are so stupid, but I can't really hate them because they save me so much money.
Sunday, October 4, 2015
Hello, October
Good news: Cimzia was delivered, which means that it is covered under my new insurance plan! This makes me love my job even more. If you know me, you probably know I'm a nerd for numbers.
Before I only ever knew the estimated cost of Cimzia. Well, here are some numbers from my latest Cimzia order. The cost of Cimzia is $3,159.68 for each month's supply. I'm responsible for 10% of that: $315.97, my co-pay. After subtracting my co-pay, the insurance company has to cover $2,843.71 of the medication. Thankfully, I have a Cimzia co-pay assistance card that covers my co-pay, $315.97, for me so that I get Cimzia for free.
Once I do my October injections that will finish my third year of taking Cimzia. Over those 36 months, I'll have injected myself 72 times. Most of the time I find it easy, but sometimes my head over thinks it and the injections freak me out. Occasionally, they hurt, bleed, or bruise. I have done all of the injections in my stomach. I could do them in my legs, but for some reason I can't bring myself to do it in my legs. Plus, I figure since it's my belly giving me the trouble it can endure to be the pincushion. Anyways, over those 36 months, insurance has saved me $102,373.56 and the Cimzia co-pay card has saved me $11,374.92 for a total savings of $113,748.48! If it wasn't for insurance or the co-pay card, I would either be really broke or really sick! Bring on year number 4!
If that's not great enough, get a load of this...
With my new insurance plan, the co-pay for Cimzia that the co-pay card covers actually counts toward my out of pocket maximum even though that money isn't coming out of my pocket. $315.97 * 12 months = $3,791.64 towards my out of pocket maximum.
I finally got my 'Stang back. I love the leather and the stitching! This car really feels too nice to belong to me.
Before I only ever knew the estimated cost of Cimzia. Well, here are some numbers from my latest Cimzia order. The cost of Cimzia is $3,159.68 for each month's supply. I'm responsible for 10% of that: $315.97, my co-pay. After subtracting my co-pay, the insurance company has to cover $2,843.71 of the medication. Thankfully, I have a Cimzia co-pay assistance card that covers my co-pay, $315.97, for me so that I get Cimzia for free.
Once I do my October injections that will finish my third year of taking Cimzia. Over those 36 months, I'll have injected myself 72 times. Most of the time I find it easy, but sometimes my head over thinks it and the injections freak me out. Occasionally, they hurt, bleed, or bruise. I have done all of the injections in my stomach. I could do them in my legs, but for some reason I can't bring myself to do it in my legs. Plus, I figure since it's my belly giving me the trouble it can endure to be the pincushion. Anyways, over those 36 months, insurance has saved me $102,373.56 and the Cimzia co-pay card has saved me $11,374.92 for a total savings of $113,748.48! If it wasn't for insurance or the co-pay card, I would either be really broke or really sick! Bring on year number 4!
If that's not great enough, get a load of this...
With my new insurance plan, the co-pay for Cimzia that the co-pay card covers actually counts toward my out of pocket maximum even though that money isn't coming out of my pocket. $315.97 * 12 months = $3,791.64 towards my out of pocket maximum.
I finally got my 'Stang back. I love the leather and the stitching! This car really feels too nice to belong to me.
Wednesday, September 30, 2015
Goodbye, September
I don't know what procrastination says about a person, but I do know I am an expert at procrastinating. If I had the energy, I would probably be stressed. I'm not stressed, just irriated that people can't do their jobs right. I have no trouble sleeping and I don't feel worried. Perhaps I'm depressed...
After leaving five messages with my nurse over a 9 day period to get a prior authorization for Cimzia, she still hadn't returned my calls or submitted the prior authorization like I requested. So, I sent my mom to the gastro office to get some answers. I sent my mom with a copy of my ID, new insurance card, and a patient disclosure form authorizing her to access my medical records. It turns out the nurse didn't call back because she didn't think the prior authorization was necessary since she gave a prior authorization for me last year. Can you believe that shit? My mom told her that she should have at least called me back to let me know she didn't feel like doing her job. Thankfully, my mom got the nurse to transfer the prior authorization from last year to my new insurance. I don't understand why the nurse couldn't just give a new prior authorization because that would last longer.
The pharmacy finally let me schedule delivery for my Cimzia, and said that insurance approved the prior authorization. Although during my first attempt today to schedule delivery, the pharmacy said that the prior authorization had been cancelled. Nobody seems to know what they're doing. I guess if Cimzia arrives when I scheduled the delivery, none of it matters.
In other news, while my car was getting leather installed they broke a bolt when they were putting the driver's seat back into the car. Now, they have to keep it in service to fix it. At least they gave me a free rental car. Plus, the leather looks and smells amazing, so it'll be worth it.
After leaving five messages with my nurse over a 9 day period to get a prior authorization for Cimzia, she still hadn't returned my calls or submitted the prior authorization like I requested. So, I sent my mom to the gastro office to get some answers. I sent my mom with a copy of my ID, new insurance card, and a patient disclosure form authorizing her to access my medical records. It turns out the nurse didn't call back because she didn't think the prior authorization was necessary since she gave a prior authorization for me last year. Can you believe that shit? My mom told her that she should have at least called me back to let me know she didn't feel like doing her job. Thankfully, my mom got the nurse to transfer the prior authorization from last year to my new insurance. I don't understand why the nurse couldn't just give a new prior authorization because that would last longer.
The pharmacy finally let me schedule delivery for my Cimzia, and said that insurance approved the prior authorization. Although during my first attempt today to schedule delivery, the pharmacy said that the prior authorization had been cancelled. Nobody seems to know what they're doing. I guess if Cimzia arrives when I scheduled the delivery, none of it matters.
In other news, while my car was getting leather installed they broke a bolt when they were putting the driver's seat back into the car. Now, they have to keep it in service to fix it. At least they gave me a free rental car. Plus, the leather looks and smells amazing, so it'll be worth it.
Tuesday, August 25, 2015
Switching Insurance Plans
At first, I wasn't concerned about switching off my parents' insurance plan and onto my own plan through work. However, I freaked out a little with the switch fast approaching.
What if my current doctors aren't in network? What if my medication is no longer covered? What if I have to find new doctors and I go into a bad flare while waiting for "new patient" appointments? What if I have to find a new doctor and they want me to do a colonoscopy?
Those thoughts above are toxic. The negative and worrisome mindset is addictive and exhausting. I had to shut it down and go back to being nonchalant about the whole thing. When dealing with insurance and doctors, I expect a crisis on the horizon. On the flip side, I am an adult and I probably have as much experience with insurance and doctors as your grandma. Plus, I have others with more experience in my corner. My plan is to take it one day at a time and handle any changes as they come because worrying about the "what if's" won't be beneficial.
Before I shut down the negative thoughts, I called my pharmacy to inquire if I had any refills available for Cimzia. To my surprise, I did. Wow, I got the refill without having to call my doctor to request it because the pharmacy communicated with my doctor! Anyways, I asked if I was cleared by insurance (still my parents') for a refill, or if I had to wait for my refill clearance to become available (I can only refill once every 3 1/2 weeks or so, so the refill window is sometimes tight). To my surprise, I was cleared for a refill. Long story short, my September dose of Cimzia was covered by my parents' insurance and will be here this week, which means I have a longer period of time to figure out my new insurance plan. It's a huge relief!
What if my current doctors aren't in network? What if my medication is no longer covered? What if I have to find new doctors and I go into a bad flare while waiting for "new patient" appointments? What if I have to find a new doctor and they want me to do a colonoscopy?
Those thoughts above are toxic. The negative and worrisome mindset is addictive and exhausting. I had to shut it down and go back to being nonchalant about the whole thing. When dealing with insurance and doctors, I expect a crisis on the horizon. On the flip side, I am an adult and I probably have as much experience with insurance and doctors as your grandma. Plus, I have others with more experience in my corner. My plan is to take it one day at a time and handle any changes as they come because worrying about the "what if's" won't be beneficial.
Before I shut down the negative thoughts, I called my pharmacy to inquire if I had any refills available for Cimzia. To my surprise, I did. Wow, I got the refill without having to call my doctor to request it because the pharmacy communicated with my doctor! Anyways, I asked if I was cleared by insurance (still my parents') for a refill, or if I had to wait for my refill clearance to become available (I can only refill once every 3 1/2 weeks or so, so the refill window is sometimes tight). To my surprise, I was cleared for a refill. Long story short, my September dose of Cimzia was covered by my parents' insurance and will be here this week, which means I have a longer period of time to figure out my new insurance plan. It's a huge relief!
Monday, November 10, 2014
Coverage for Cimzia is Denied... Or Is It?
Monday, November 2nd, 2014 my gastro nurse faxed a prior authorization form to my specialty pharmacy for insurance to review.
Friday, November 6th, 2014 my insurance was "unable to approve [my] physician's request for coverage of CIMZIA. The request did not meet the conditions necessary for coverage for the following reason(s)."
"The request for coverage for Cimzia is denied. This decision is based on health plan criteria for Cimzia. This medicine is covered if you meet the following criteria: You have positive clinical response to Cimzia therapy. The information sent in does not show you meet these criteria."
I quoted the above from a letter I received from my insurance. The letter also included a page of information and guidelines about the appeals process.
Sunday, November 9th, 2014, I reached out to a Team Challenge mentor, Tom, for advice on this situation. Tom let me speak to his badass wife, Liz, because she's the one that has handled a few of these situations for their son with Crohn's disease. Before speaking with Liz I felt hopeless and lost because I really didn't know what I should do. Liz advised me to contact insurance first and get a specific answer as to why they decided to deny coverage. Liz also counselled me to inquire about what I can do to regain coverage without having to go through the appeals process. She told me to stand firm and not to take no for an answer. She then instructed me to call her back if my call to insurance doesn't find a solution. By the end of our conversation, Liz had calmed my nerves about the situation. It was nice to know that I have someone on my team with experience coaching me to win this enduring struggle with insurance.
Today, November 10th, 2014, I contacted insurance. It took five minutes convincing the automated robot to let me speak to a human before I actually got a human on the line. The human's name was Craig. The following is paraphrased after Craig confirmed who I was and my insurance plan:
Me: I'm calling to find out why coverge of my Cimzia medication was denied.
Craig: It looks like we won't cover the brand name Cimzia, but we will cover the generic brand Certolizumab Pegol.
Me: Cimzia does not have a generic brand. I have been taking Cimzia for the past two years, which you guys have covered for the past two years. Why the sudden change in coverage?
In the meantime I'm googling "Certolizmab Pegol" to figure out where he is getting this name from because I know for a fact that there is no generic brand of Cimzia and the first hit on Google takes me to http://www.cimzia.com/. I conclude that Certolizmab Pegol is the clinical or scientific name for the medication Cimzia, which my gasto nurse confirms later in the day.
Craig: We have not ever covered Cimzia. We have covered the generic Certolizumab Pegol.
Me: Certolizumab Pegol is Cimzia.
Craig: No, we will not cover Cimzia.
At this point you can imagine my confusion.
Me: Okay, so do I get approved for this so called generic?
Craig: Have your doctor send another prior authorization for the generic or have your doctor contact us at an 1-800 #.
Me: So, if my doctor sends you guys a prior authorization for Certolizumab Pegol, it will be approved?
Craig: Yes.
Me: Okay, so you won't approve Cimzia, but you'll approve Certolizumab Pegol, which is the same thing as Cimzia?
Craig: It's the generic brand of Cimzia.
This ended my conversation with Craig, the dumb human voice of the insurance company.
I followed my call with Craig with a call to my gastro nurse, Osmarie. She explained that the prior authorization paper work she got to fill out had check boxes with Humira, Cimzia, or Remicade (these medications do not have a generic form. They are too new and too complex). It just prompted her to check a box, so she checked the Cimzia box. There wasn't even a space on the paperwork for her to write in Certolizumab Pegol, so she called the 1-800 # I gave her. Within the hour she got the confirmation that insurance approved Certolizumab Pegol. Osmarie told me that is just the clinical name for Cimzia and that there is no generic brand for Cimzia.
This whole ordeal has left me dumbfounded. Insurance makes me cry, shake my head, and smile at their stupidity. My medication has been approved! I call it Cimzia. Insurance calls it Certolizumab Pegol. Just don't tell them that Certolizumab Pegol is Cimzia, or they might decide not to cover it. It will be delivered just in time for my scheduled November injections.
Friday, November 6th, 2014 my insurance was "unable to approve [my] physician's request for coverage of CIMZIA. The request did not meet the conditions necessary for coverage for the following reason(s)."
"The request for coverage for Cimzia is denied. This decision is based on health plan criteria for Cimzia. This medicine is covered if you meet the following criteria: You have positive clinical response to Cimzia therapy. The information sent in does not show you meet these criteria."
I quoted the above from a letter I received from my insurance. The letter also included a page of information and guidelines about the appeals process.
Sunday, November 9th, 2014, I reached out to a Team Challenge mentor, Tom, for advice on this situation. Tom let me speak to his badass wife, Liz, because she's the one that has handled a few of these situations for their son with Crohn's disease. Before speaking with Liz I felt hopeless and lost because I really didn't know what I should do. Liz advised me to contact insurance first and get a specific answer as to why they decided to deny coverage. Liz also counselled me to inquire about what I can do to regain coverage without having to go through the appeals process. She told me to stand firm and not to take no for an answer. She then instructed me to call her back if my call to insurance doesn't find a solution. By the end of our conversation, Liz had calmed my nerves about the situation. It was nice to know that I have someone on my team with experience coaching me to win this enduring struggle with insurance.
Today, November 10th, 2014, I contacted insurance. It took five minutes convincing the automated robot to let me speak to a human before I actually got a human on the line. The human's name was Craig. The following is paraphrased after Craig confirmed who I was and my insurance plan:
Me: I'm calling to find out why coverge of my Cimzia medication was denied.
Craig: It looks like we won't cover the brand name Cimzia, but we will cover the generic brand Certolizumab Pegol.
Me: Cimzia does not have a generic brand. I have been taking Cimzia for the past two years, which you guys have covered for the past two years. Why the sudden change in coverage?
In the meantime I'm googling "Certolizmab Pegol" to figure out where he is getting this name from because I know for a fact that there is no generic brand of Cimzia and the first hit on Google takes me to http://www.cimzia.com/. I conclude that Certolizmab Pegol is the clinical or scientific name for the medication Cimzia, which my gasto nurse confirms later in the day.
Craig: We have not ever covered Cimzia. We have covered the generic Certolizumab Pegol.
 |
| A photo of my Cimzia medication they have been covering for two years. You can see in parenthesis under Cimzia the Certolizumab Pegol name. |
Me: Certolizumab Pegol is Cimzia.
Craig: No, we will not cover Cimzia.
At this point you can imagine my confusion.
Me: Okay, so do I get approved for this so called generic?
Craig: Have your doctor send another prior authorization for the generic or have your doctor contact us at an 1-800 #.
Me: So, if my doctor sends you guys a prior authorization for Certolizumab Pegol, it will be approved?
Craig: Yes.
Me: Okay, so you won't approve Cimzia, but you'll approve Certolizumab Pegol, which is the same thing as Cimzia?
Craig: It's the generic brand of Cimzia.
This ended my conversation with Craig, the dumb human voice of the insurance company.
I followed my call with Craig with a call to my gastro nurse, Osmarie. She explained that the prior authorization paper work she got to fill out had check boxes with Humira, Cimzia, or Remicade (these medications do not have a generic form. They are too new and too complex). It just prompted her to check a box, so she checked the Cimzia box. There wasn't even a space on the paperwork for her to write in Certolizumab Pegol, so she called the 1-800 # I gave her. Within the hour she got the confirmation that insurance approved Certolizumab Pegol. Osmarie told me that is just the clinical name for Cimzia and that there is no generic brand for Cimzia.
This whole ordeal has left me dumbfounded. Insurance makes me cry, shake my head, and smile at their stupidity. My medication has been approved! I call it Cimzia. Insurance calls it Certolizumab Pegol. Just don't tell them that Certolizumab Pegol is Cimzia, or they might decide not to cover it. It will be delivered just in time for my scheduled November injections.
Thursday, May 15, 2014
Cimzia - Part 2
During my big flare of 2012, my doctor pretty much listed and explained the different treatment options and told me to choose one. Shouldn't that be his job? I originally chose Humira, but insurance wouldn't cover it. So, basically it was insurance who picked how I would be treated and they happened to choose Cimzia because of some deal the insurance company has with the pharmaceutical company that makes the drug.
I went through blood tests, was tested for tuberculosis and my doctor quizzed me on other health issues to make sure it was safe for me to start Cimzia. This is a serious drug and for good reason. I educated myself on Cimzia by reading the medication guide and the fine print of the prescribing information before starting treatment. After reading what I read, I was scared to start Cimzia. It's a relatively new drug and long term affects are unknown. I knew I would be taking it long term as long as my body doesn't build antibodies and reject it. It's not a drug I can go on and off of as symptoms come and go because then it's a higher risk of my body building antibodies against it. The two things that scare me the most with taking Cimzia are the increased risk of developing serious infections that may lead to death and the chances of getting lymphoma or other cancers may increase.
Health wise, I was in a rough place when I first started Cimzia. Clearly, the risks of taking the drug were worth it as long as Cimzia could relieve me of the horrible Crohn's symptoms I was experiencing. Well, for the most part Cimzia has helped me, but the side effects are sometimes annoying. Which is worse the side effects of Cimzia or the symptoms of Crohn's? Side effects I've experienced have been minor ones compared to some of the ones listed on the medication guide. Some of the side effects listed are:
I went through blood tests, was tested for tuberculosis and my doctor quizzed me on other health issues to make sure it was safe for me to start Cimzia. This is a serious drug and for good reason. I educated myself on Cimzia by reading the medication guide and the fine print of the prescribing information before starting treatment. After reading what I read, I was scared to start Cimzia. It's a relatively new drug and long term affects are unknown. I knew I would be taking it long term as long as my body doesn't build antibodies and reject it. It's not a drug I can go on and off of as symptoms come and go because then it's a higher risk of my body building antibodies against it. The two things that scare me the most with taking Cimzia are the increased risk of developing serious infections that may lead to death and the chances of getting lymphoma or other cancers may increase.
Health wise, I was in a rough place when I first started Cimzia. Clearly, the risks of taking the drug were worth it as long as Cimzia could relieve me of the horrible Crohn's symptoms I was experiencing. Well, for the most part Cimzia has helped me, but the side effects are sometimes annoying. Which is worse the side effects of Cimzia or the symptoms of Crohn's? Side effects I've experienced have been minor ones compared to some of the ones listed on the medication guide. Some of the side effects listed are:
- Heart Failure (No, I haven't experienced this)
- Nervous System Problems. (No, I haven't experienced this)
- Allergic Reactions. (No, I haven't experienced this)
- Blood Problems (Yes, I'm anemic, but that could be from the disease)
- Upper respiratory infections (Yes, I've experienced this)
- Rash. (No, I haven't experienced this)
- Urinary tract infections (Yes, I've experienced this)
- Injection site reactions (Yes, I've experienced this)
Wednesday, May 14, 2014
Cimzia - Part 1
After a couple of weeks with some moderate, uncomfortable stomach pain, I woke up this morning with no pain at all. What a relief! I gave myself the Cimzia injections last night, but I didn't think they'd help this quickly. I was able to take deeper breaths, stand up taller, and walk with a pep in my step. I could...move! I felt like running, which I haven't had the desire to do for nearly two months. So, what is Cimzia and how does it treat Crohn's?
First, let's look at what Crohn's disease is. It's an autoimmune disease. Basically, my immune system mistakenly attacks bacteria that are naturally present in my gut. I like the paragraph below from http://www.ccfa.org/what-are-crohns-and-colitis/what-is-crohns-disease/ because I think it simply explains it in more detail.
The GI tract normally contains harmless bacteria, many of which aid in digestion. The
immune system usually attacks and kills foreign invaders, such as bacteria, viruses,
fungi, and other microorganisms. Under normal circumstances, the harmless bacteria
in the intestines are protected from such an attack. In people with IBD, these bacteria
are mistaken for harmful invaders and the immune system mounts a response. Cells
travel out of the blood to the intestines and produce inflammation (a normal immune
system response). However, the inflammation does not subside, leading to chronic
inflammation, ulceration, thickening of the intestinal wall, and eventually causing
patient symptoms.
This is really all we need to understand about Crohn's in order to understand how Cimzia treats the disease.
Second, before I get into how Cimzia treats Crohn's, I want to make sure it's clear that Cimzia does not cure Crohn's it only treats the disease. I know it's crazy about $3,000 each month for a drug that doesn't even cure me. Luckily, with insurance and a co-pay card I get it for free. Cimzia is a biologic medication, which means its derived, in some way, from living organisms. As you can imagine, biologic meds are complex and I don't even begin to understand how they're made, but it's interesting to research even though the science behind it is way over my head. Cimzia is used to treat numerous autoimmune conditions, not just Crohn's. The easiest way to explain Cimzia is to cite from its website: http://www.cimzia.com/crohns-disease/crohns-symptoms/crohns-disease-medication-information.aspx
In people with Crohn's disease, the immune system produces too much of a protein
called tumor necrosis factor-alpha (TNF-alpha). TNF-alpha triggers inflammation,
which can lead to inconvenient and often painful symptoms, some of which can cause
damage to your gastrointestinal tract
CIMZIA blocks the action of TNF, a substance produced by cells of the immune
system to induce inflammation. CIMZIA is the first and only PEGylated biologic
treatment for Crohn's disease. PEGylation has been shown to help the medicine stay
in the body.
The way I understand it is that TNF is responsible for attacking the good bacteria and causes the inflammation. Cimzia is a TNF blocker, so it blocks the TNF, which reduces inflammation and reduces symptoms. One of the dangerous things about taking a drug that blocks TNF is that I have no immune system that will come to my rescue to fight foreign invaders, like infections.
In conclusion, sometimes I wonder how I can be okay with injecting such a powerful drug into my body. The body is a temple, right? Cimzia stops my body from working the way it's supposed to work. My reasoning is that if I left my body alone (without drugs) to work how it's supposed to work, it malfunctions and causes me pain. Sometimes I'm not okay with that reasoning. Especially, when I think of all the side effects and risk factors associated with the drug. I'll save that for the topic of part 2.
First, let's look at what Crohn's disease is. It's an autoimmune disease. Basically, my immune system mistakenly attacks bacteria that are naturally present in my gut. I like the paragraph below from http://www.ccfa.org/what-are-crohns-and-colitis/what-is-crohns-disease/ because I think it simply explains it in more detail.
The GI tract normally contains harmless bacteria, many of which aid in digestion. The
immune system usually attacks and kills foreign invaders, such as bacteria, viruses,
fungi, and other microorganisms. Under normal circumstances, the harmless bacteria
in the intestines are protected from such an attack. In people with IBD, these bacteria
are mistaken for harmful invaders and the immune system mounts a response. Cells
travel out of the blood to the intestines and produce inflammation (a normal immune
system response). However, the inflammation does not subside, leading to chronic
inflammation, ulceration, thickening of the intestinal wall, and eventually causing
patient symptoms.
This is really all we need to understand about Crohn's in order to understand how Cimzia treats the disease.
Second, before I get into how Cimzia treats Crohn's, I want to make sure it's clear that Cimzia does not cure Crohn's it only treats the disease. I know it's crazy about $3,000 each month for a drug that doesn't even cure me. Luckily, with insurance and a co-pay card I get it for free. Cimzia is a biologic medication, which means its derived, in some way, from living organisms. As you can imagine, biologic meds are complex and I don't even begin to understand how they're made, but it's interesting to research even though the science behind it is way over my head. Cimzia is used to treat numerous autoimmune conditions, not just Crohn's. The easiest way to explain Cimzia is to cite from its website: http://www.cimzia.com/crohns-disease/crohns-symptoms/crohns-disease-medication-information.aspx
In people with Crohn's disease, the immune system produces too much of a protein
called tumor necrosis factor-alpha (TNF-alpha). TNF-alpha triggers inflammation,
which can lead to inconvenient and often painful symptoms, some of which can cause
damage to your gastrointestinal tract
CIMZIA blocks the action of TNF, a substance produced by cells of the immune
system to induce inflammation. CIMZIA is the first and only PEGylated biologic
treatment for Crohn's disease. PEGylation has been shown to help the medicine stay
in the body.
The way I understand it is that TNF is responsible for attacking the good bacteria and causes the inflammation. Cimzia is a TNF blocker, so it blocks the TNF, which reduces inflammation and reduces symptoms. One of the dangerous things about taking a drug that blocks TNF is that I have no immune system that will come to my rescue to fight foreign invaders, like infections.
In conclusion, sometimes I wonder how I can be okay with injecting such a powerful drug into my body. The body is a temple, right? Cimzia stops my body from working the way it's supposed to work. My reasoning is that if I left my body alone (without drugs) to work how it's supposed to work, it malfunctions and causes me pain. Sometimes I'm not okay with that reasoning. Especially, when I think of all the side effects and risk factors associated with the drug. I'll save that for the topic of part 2.
Thursday, January 2, 2014
I Strongly Dislike Robots
Every month I get a call from robots at Optum Rx reminding me to refill my Cimzia prescription. "Your call may be monitored for quality assurance." Regardless of whether I stay on the line and order the refill or call back to order it, the first thing I have to do is tell a robot my birthday, zip code, and phone number.
It's comical because the robot always misunderstands me and wants me to repeat what I said even though I'll have to repeat it two additional times once I get a human on the line to verify it's me placing the order on my "file." I've thought of possible solutions. I can't change pharmacies because my insurance forces me to use Optum Rx in order to get coverage on my prescription. I can't go without insurance because that will soon be against the law and plus this drug is about $3,600 a month. I've tried typing in the info using the key pad on my touch screen phone, but I usually end up with a typo and then I have to start over. My solution is to be as rude as possible to the robot! As soon as it starts asking for my info, I cut it off and say something like, "Why should I tell you, I'll just have to repeat it again to your humans." If you don't believe me, ask my sister.
Without hesitation the robot responds with something like "I'm sorry I don't understand human, let me connect you with an Optum Rx representative. "
Score, I out smarted the robot and get put on hold to wait for the next available rep! In the meantime, while I'm on hold I talk about how much I dislike Optum Rx and all of the nonsense the robotic system is. I want those mysterious folks monitoring my call to know how much time is wasted while trying to communicate with a robot. By this point I've decided that the calls are probably monitored by robots and they have marked my file up and down with notes. The notes would read: "Put this customer on hold often for no reason." "She's a robot hater so make sure to make her repeat her info at least twice." After some time on hold, I then proceed to tell the human rep my info and then they put me on a longer hold to transfer me to the specialty department.
I strike up another one sided, hostile conversation with the robotic monitors before having to spill my info again to the human specialty department. The specialty department always wants additional info like my address and the name of the doctor that prescribed my prescription so that they can look up my "file," but only after they put me on another hold. If they're so special, why do they need more info than the first rep to look up my file? I think it's because the robots are undergoing a slow takeover of that department, or the human saw the notes in my file. On average it can take anywhere between 10 to 15 minutes on the phone to complete my order. I usually don't even talk that long on the phone with my mom.
As much as I joke about the robots I strongly dislike them and how impersonal they make everything. Maybe if they were smarter or dumb enough to understand me I would like them. Perhaps I'm just not smart enough to understand them. No matter, I know there has to be a better, more effective way for Optum Rx to handle refills.
It's comical because the robot always misunderstands me and wants me to repeat what I said even though I'll have to repeat it two additional times once I get a human on the line to verify it's me placing the order on my "file." I've thought of possible solutions. I can't change pharmacies because my insurance forces me to use Optum Rx in order to get coverage on my prescription. I can't go without insurance because that will soon be against the law and plus this drug is about $3,600 a month. I've tried typing in the info using the key pad on my touch screen phone, but I usually end up with a typo and then I have to start over. My solution is to be as rude as possible to the robot! As soon as it starts asking for my info, I cut it off and say something like, "Why should I tell you, I'll just have to repeat it again to your humans." If you don't believe me, ask my sister.
Without hesitation the robot responds with something like "I'm sorry I don't understand human, let me connect you with an Optum Rx representative. "
Score, I out smarted the robot and get put on hold to wait for the next available rep! In the meantime, while I'm on hold I talk about how much I dislike Optum Rx and all of the nonsense the robotic system is. I want those mysterious folks monitoring my call to know how much time is wasted while trying to communicate with a robot. By this point I've decided that the calls are probably monitored by robots and they have marked my file up and down with notes. The notes would read: "Put this customer on hold often for no reason." "She's a robot hater so make sure to make her repeat her info at least twice." After some time on hold, I then proceed to tell the human rep my info and then they put me on a longer hold to transfer me to the specialty department.
I strike up another one sided, hostile conversation with the robotic monitors before having to spill my info again to the human specialty department. The specialty department always wants additional info like my address and the name of the doctor that prescribed my prescription so that they can look up my "file," but only after they put me on another hold. If they're so special, why do they need more info than the first rep to look up my file? I think it's because the robots are undergoing a slow takeover of that department, or the human saw the notes in my file. On average it can take anywhere between 10 to 15 minutes on the phone to complete my order. I usually don't even talk that long on the phone with my mom.
As much as I joke about the robots I strongly dislike them and how impersonal they make everything. Maybe if they were smarter or dumb enough to understand me I would like them. Perhaps I'm just not smart enough to understand them. No matter, I know there has to be a better, more effective way for Optum Rx to handle refills.
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