Docetaxel starting mid-Dec, insurance doesn't pay for Neulasta to keep white blood cell count good. Uh..pandemic anybody?

[HerbieP]

Low immunity caused by chemo during a pandemic doesn't sound very good to me, though I am doing Jane McLlelands supplements and COC which should help.

Questions for my cousins in cancer:

1) Would you start chemo now during a pandemic knowing your white blood cell count will go to crap, and you can't do anything proactively about it due to insurance refusal? ADT, Oriectomy and immunotherapy already completed, PSA rising again. I know the risk of infection during chemo is bad, but I think it's tons worse given the pandemic (I have a kid in college in the house as well).

2) Would you go into debt to pay for Neulasta (or equivalent white blood cell magic) out of pocket (it'd be like buying a luxury car)?

Advice? Opinions? Jokes? - Thanks, Herbie

[Tall_Allen]

Can you appeal the Neulasta refusal?

[HerbieP in reply to Tall_Allen]

Yes I will be appealing, thanks. The nurse told me they've not seen folks with private insurance win until the cell count gets low enough to justify and I don't like that prognosis.

[pleinairpainter in reply to HerbieP]

Hello Herbie, Last year, at this time, the original insurance denial for my Neulasta was successfully circumvented thanks to the hospital's patient advocate tapping a Neulasta program. In January 2020 on my new health plan, I was hit with an impressive bill and found out that I was being charged for the Neulasta treatments (I think, it was roughly $1645 each). After a lot of paperwork, frustration from denials and wrong turns; and the incredible support of patient advocates from several programs (my insurance, my hospital, and the oncology department itself), there was finally success in finding funds to pay for all of it. Also, you may want to investigate other possibilities to find funds. During my nearly four-year cancer battle, over half-a-dozen Philadelphia- and several Manhattan-region charities have helped us: providing us with groceries; and funds to cover medical or household expenses. These charitable hand outs did (do) help us in the financial struggle that accompanies any of our cancer battles. It is hard enough not to go into debt with costs associated with cancer (the NCI has a designated medical term for it: financial toxicity). Demand the treatment and financial help you need and deserve. Good luck!

[monte1111]

How about just buying the Love Bug? My white blood cell count was at 2% and I had shots for three days following chemo with Zarzio. So, other choices besides Neulasta. Others that know more will chime in. The Zarzio worked great and I had no issues except very bad leg pain. I did not know about taking Claritin. Sounds like insurance just wants to pay for a cheaper drug. (Wasn't given neutropenia treatment until after 2nd or 3rd chemo when white blood cells dropped. )

[HerbieP in reply to monte1111]

Thanks - I'll add Zarzio to my questions for the Oco's list.

[Hidden]

I would say you most likely need Neulasta. I didn't use it after my first course of Docetaxel and my WBC went down to 1.1, my ANC bottomed out at 0.50. Neulasta used to have a financial assistance program. Current status unknown. I'm supposing you have talked to your Oncologist about the matter. Many times a member of their staff have information leading to financial assistance for specific drugs. Good Luck.

[Shooter1]

May not need it. I did 9 cycles of chemo instead of 6 and white blood count didn't drop more than 10%. Just lucky I guess.

[cesces]

Sometimes insurance requirements are rational.

And every drug strong enough to help, usually is strong enough to do damage, including side effects.

So start by educating yourself about both the pros and the cons. And about what levels they require for approval.

[_Kristina]

If they denied neulasta, they should at least approve Zarzio, which is cheaper but gets the job done.

[EdBar]

When I had chemo they didn’t add Neulasta until WBC got very low which was after the first or second round. I’d be surprised if insurance didn’t cover it. It’s SOC.

Ed

[abmicro]

Have you tried running Zarxio self injections thru your drug plan? Big copays, but might pass your drug plan. 7 daily injections starting day of chemo should be enough.

[monte1111 in reply to abmicro]

Zarxio, Zarzio - same or similar? It could have been Zarxio that I had 3 daily shots after chemo. I had to go to hospital to get shots, as doctor said self injections would be very costly. The stress caused by insurance is insane. The rules are stupid. Who can understand any of this?

[abmicro in reply to abmicro]

FYI, contacted Novartis and got this drug for free based on low income. I am a fan of white cell boosters because Dr Charles E Myers had me on Leukine in 2008 for 3 years. He had me run 2 months at higher dose of Leukine then cut it back to 2wks on and 2wks off. I ran other drugs in his protocol as well. I read posts where white cell boosters helped many treatments to make them more effective. I am a fan of combos. 2 or 3 is better than 1.

[Union98]

My husband did not use Neulasta during his 6 treatments with taxotere in 2017. He worked from home part of the time, played gigs with his band every third week, and used tons of hand sanitizer and Lysol spray when he did go to work and wore a mask (before it was "cool"). That said, we both did research and he decided to ask for a reduced dose of taxotere in order to keep the white blood counts under control. His first treatment was at 100%, 2nd at 80% and the remaining 4 at 90% dosage. He's still going strong - band gigs (not since Covid though) and working full time from home in a very stressful job. Currently on Zytiga & ADT. Did Provenge 2 years ago.

Have you tried Zytiga or Xtandi? If not, something to think about trying before chemo.

[HerbieP in reply to Union98]

We sound in a similar situation. I've done Zytiga, Provenge (1.5 years ago), and then Erleada and my PSA just started creeping up again. My Onco's never discussed the % dose, did you guys bring that up or did your Dr.? Good for him re: working and gigging still (tho I'm no longer a fan of work stress).

[Union98 in reply to HerbieP]

Our research showed that the doseage of taxotere was the same for everyone no matter the weight or height, because it was based on the CHARTTED trial information. After his WBC went down quickly on his first treatment, he talked to the doctor about reducing the doseage. He wasn't really on board but he didn't fight my husband's decision. After the second treatment, at 80%, his WBC barely budged so it was agreed to up it to 90% which worked the best and made everyone happy. Granted we were new to researching drug trials and were bound and determined to take his cancer treatments on his terms, working with the doctor not obeying him blindly. We were very lucky in getting our current MO who although doesn't specialize in prostate cancer, is open to listening to his patients and guiding treatments with the patient in mind. He also consults with a MO in his practice that does specialize in PCa so we know we have those resources when needed. I've become quite the armchair doctor (even people at work ask my advice on their illnesses - probably because I don't charge a co-pay lol) with my research.

[Cleodman]

Your insurance most likely won’t pay for Neulasta as prophylaxis but when/if you become neutropenic they will. I went through the same. Kinda silly as a hospital stay for neutropenic fever is much more expensive but insurance will do anything to save on their end.

I would not put too much faith in the supplements to keep your WBC up.

[Prostratehelp]

There are other drugs that can be used to increase white blood count after chemo.

I am currently on chemo (Gemzar) and receive Zarxio injection 2 days after chemo session. I take Claritin D to reduce to side effects. It must be the “D” version of Claritin as it has the antihistamines that reduce the side effects.

I am on Gemzar because it was found that I am allergic to Docetaxel. Had severe reaction and they had to bring in the “crash cart” to bring me out of it. Gemzar appears to be working as my PSA has started to come down.

Good luck,

[HerbieP in reply to Prostratehelp]

Claritin D for which side effects? Gemzar or Zarxio?

[Prostratehelp in reply to HerbieP]

Claritin D is for the Zarixo.

[abmicro in reply to Prostratehelp]

Ditto. White cell boosters can increase bone pain for a week. Claritin is a trick to reduce inflammation and pain.

[carbide]

Yes, start cemo.

Request a grant for Neulasts, via doctor, his drug pharmacy or go direct to Neulasts site.

Best luck.

[abmicro in reply to carbide]

Ditto

[HerbieP in reply to carbide]

Thank you, done!

[abmicro]

zarxio also has a low income grant program. I am in it and I get it for free.

[j-o-h-n]

To pay for your meds, kill two birds with one stone....

Sell the kids......

Well, you asked for it.......

Good Luck, Good Health and Good Humor.

j-o-h-n Tuesday 11/10/2020 6:42 PM EST