BC/BS will pay 80% but after what Medicare won't pay there's an $1,100
gap per infusion. Ouch.
So they'll call me back to schedule me to come in early to see which of
the self-injectables I might be able to use. I'm kinda leaning away from
Enbrel and more toward Kineret and the like.
I'm prone to clotting in feet and hands due to peripheral neuropathy
and I have FM. Anything particularly good at staving off DJD and DDD damage?
Any and all suggestions from actual Gimps warmly received. TIA!
ASA Hugs from Rosie

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"If you wanna get it done, you gotta fight for yourself." -- Meat Loaf, Bat
Outta Hell II
Kimmy - 11 May 2006 02:22 GMT
I'm no help with advice. Nothing pi$$es me off more than hearing
someone can't get a med because the insurance company won't cough up
the dough.
I'm sorry Rosie. Gonna say a little prayer that ya find something that
works *and* that's affordable.
Love ya,
Kimmy
Smokie Darling (Annie) - 11 May 2006 15:31 GMT
> BC/BS will pay 80% but after what Medicare won't pay there's an $1,100
> gap per infusion. Ouch.
[quoted text clipped - 12 lines]
> "If you wanna get it done, you gotta fight for yourself." -- Meat Loaf, Bat
> Outta Hell II
Oh Rosie, I'm sorry. I hate when insurance decides our "fate" rather
than our doctors.
Let's see, the Cytoxan worked, but you may not want the side effects,
and I'm still waiting to what portion is mine to pay. The hospital
says that Medicare did pay some of it, which I find interesting since
it isn't (?) approved for use with RA. It was also much less expensive
than the Rituxan (I'll take the $1500 as opposed to $12000 per
infusion).
Of course, C has a ton of side effects that aren't a lot of fun (as I'm
sure you've heard). The worst being the nausea (get used to camping
out in the bathroom) after they get you set at the "regular" dose of it
(after the "build up").
I hope that you find that magic bullet.
I think I'll be starting on Orencia in June. The RD didn't want me on
Cytoxan more than 6 months, and now we know a drug that works really
well for me, in the short term. So... At least I've got a fall back
drug now when the new ones don't work.
([([([gentle cyber hugs])])])
Smokie Darling (Annie)
Nann Bell - 11 May 2006 16:47 GMT
argh! the flaming hoops we must jump through. Is there anyone down there
doing any studies you might be able to get in on?
IIRC, Kineret is the one that really hurts going in, to the point of
requiring icing before injecting. Might be something to keep in mind, I
don't know if the fibro would make that even worse.
I'll bet the one that's best against DJD and DDD is the one that most
suppreses inflammation for you. NOt much help there, I know! One of these
days, they will be able to tell in advance by testing our blood. Until then,
I'll send a few pleas heavenward that you find the winner on the first try!

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Nann
remove the Gator cheer to email me
Simply the thing I am shall make me live --- William Shakespeare
Charrlygrl1 - 11 May 2006 18:23 GMT
Rosie, this sucks!
Would there be any chance of contacting the Rituxan people to see if
they have any programs for the under insured or the just sucky
insurance insured?
I have a link here which includes the makers of Enbrel and - oh look!
It also includes Rituxan!! Maybe they could chip in a bit, since you do
have the bulk of it covered?
http://www.rheumatology.org/public/acrast.asp?aud=pat
I don't really have any advice for you, since so far I've only been on
Enbrel as far as the biologics go. I've read a lot regarding reactions
to Remicade, but that's all I've got.
Is the same situation (regarding the high cost you have to pay) going
to come up with the other meds (Kineret or whatever)?
Rosie, this really sucks. I'll be sending some good vibes your way.
Please let us know how you make out and what med you chose,
Char
Paul T. Holland - 11 May 2006 21:45 GMT
don't know if you have seen this - in theory, retuxin is part of this program
All of Genentech's products are covered by the Genentech® Access to Care
Foundation, except for Pulmozyme® (dornase alfa), which is covered by the
Genentech Endowment for Cystic Fibrosis. For consideration of eligibility for
resources from the Genentech® Access to Care Foundation, the patient must meet
eligibility criteria including income restrictions. Please direct requests for
applications forms and more specific information on eligibility to:
Genentech Access to Care Foundation
1 DNA Way, MS #13A
South San Francisco, CA 94080
for those 'without' insurance
(800) 530-3083 option 2 for rituxin
FAX: (650) 225-1366
for those 'with' insurance that doens't cover all of cost
Single Point of Contact-SPOC:
888-249-4918 option 1
handle those with insurance
hth
paul
> BC/BS will pay 80% but after what Medicare won't pay there's an $1,100
> gap per infusion. Ouch.
[quoted text clipped - 12 lines]
> "If you wanna get it done, you gotta fight for yourself." -- Meat Loaf, Bat
> Outta Hell II
Duckie - 12 May 2006 10:27 GMT
Rats -- no way the company would help bridge that gap is there. Who
manufactures Rituxan anyway.
How many infusions were there to be? I had four. Wonder if the manuf.
would kick in that bit.
Is KJ still on Kineret? I remember her and a few others having trouble
with the burning on that one.
Duckie
> BC/BS will pay 80% but after what Medicare won't pay there's an $1,100
> gap per infusion. Ouch.
[quoted text clipped - 8 lines]
>
> ASA Hugs from Rosie
melodymom - 15 May 2006 06:46 GMT
:( {{{{{{{Rosie}}}}}}}
luv&stuff,
Denise
(Who didn't mean to lie about being home/gone on Saturday...)
Squirrely - 15 May 2006 16:28 GMT
It was my fault Rosie, I was suppose to tell you that when you called and I
spaced it till hours after your call.
Good we talked when we did because now I don't feel like talking to anyone.
;-)

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Love and hugs Jo
(\__/) .~ ~. ))
/O O ./ .'
{O__, \ {
/ . . ) \
|-| '-' \ } )) Warning: squirrels.
.( _( )_.'
'---.~_ _ _&
"
> :( {{{{{{{Rosie}}}}}}}
>
> luv&stuff,
> Denise
> (Who didn't mean to lie about being home/gone on Saturday...)
melodymom - 15 May 2006 21:39 GMT
Your boys let you down? :(
luv&stuff,
Denise if this is ASA