Mom has had anemia for some time; both low iron and low hemoglobin counts. She’s been taking iron supplements for over a year. In mid-December, her hemoglobin count dropped to 6.7, which required an overnight stay in the hospital and transfusion of two units of blood. Even after the transfusions, they only got the count up to 8.3. (A healthy RBC count is around 10-12.) The anemia is being treated by her nephrologist because it is often caused (at least partially) by chronic kidney disease.
Recently the nephrologist prescribed injections of a drug called Procrit, which stimulate the body’s production of red blood cells. The drug is expensive and requires preauthorization for insurance coverage, which took us a few weeks to obtain. I was thrilled when we obtained the preauth, but when the specialty pharmacy called to tell me the medication was ready, I had sticker shock: 6 shots, a 3-month supply, was going to cost us over $1100 out of pocket.
I got the pharmacy to fill just two doses (at a cost of $367) for now, since we simply don’t have $1100 to splash out all at once. Mom got her first injection on Wednesday. It’s not a fast-acting drug, so we won’t know for at least 2-3 weeks what kind of difference it’s making. Also, from what the medical assistant who gave her the shot said, it’s a maintenance drug that needs to be continued; if she goes off it, her RBC count is likely to drop again. And if it drops below 7, back to the hospital for transfusions she goes.
The specialty pharmacy gave me a courtesy call yesterday, and I explained that we don’t know how we’re going to pay for this medication yet. They transferred me to a department that helps patients apply for co-pay assistance, and I was given information on three foundations that help Medicare patients with co-pays. Long story short: Hopes up, then dashed again. I’ve spent the last two hours on the phone and on websites for these three foundations, and all of them have funds available ONLY for people with specific diseases. If Mom had cancer and her anemia had been caused by chemotherapy, she would qualify for assistance. If she had any number of other specific diseases, she could qualify for assistance. But nobody seems to have funds available for a Medicare patient with anemia due to stage IV chronic kidney disease.
I’m feeling very discouraged right now.