Insurance co. denies Neulasta

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Tuesday I will have my first chemo treatment for Stage IIIc2 endometrial cancer. (Had a TAH last month.) Today I received a letter from my insurance company denying coverage for Neulasta on the grounds that "the specific treatment you are receiving puts you at low risk for febrile neutropenia." Tomorrow I will call my doctor to discuss but I'd like to know if anyone here has experience one way or the other with Neulasta in conjunction with Carboplatin + Paclitaxel. I won't be taking it if it means paying for it out of pocket. From what I've read about the side effects, it may not be such a bad thing if I have to skip it. Thanks in advance for your thoughts.

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  • EZLiving66
    EZLiving66 Member Posts: 1,483 Member
    edited June 2016 #2
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    My oncologist's PA told me

    My oncologist's PA told me that most insurance companies won't pay for the Neulasta shot until they see a need for it.  Medicare will pay for it for the first time.  I had to wait until my white blood count tanked and then they ok'd it.  I had terrible pain with it and only had that one shot.  I decided I'd just stay home so I didn't get an infection.

    Good luck and welcome to the best group of "unlucky" ladies you'll ever meet!!!

    Love,

    Eldri

     

  • debrajo
    debrajo Member Posts: 1,095 Member
    edited June 2016 #3
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    shot

    I had six rounds of Taxol/Carboplatin and never needed the shot.  Some people just dont, probably why the insurance company has a wait-and-see policy.  Debrajo

  • Editgrl
    Editgrl Member Posts: 903 Member
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    I, too, had six rounds of

    I, too, had six rounds of Carboplatin/Taxol, didn't get Neulasta and my blood counts never got too low to postpone treatment.

    Chris

     

  • beccabtown
    beccabtown Member Posts: 234
    edited June 2016 #5
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    Thanks for all the comments.

    Thanks for all the comments. They're very helpful.

  • NoTimeForCancer
    NoTimeForCancer Member Posts: 3,385 Member
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    Ditto to debrajo and Chris'

    Ditto to debrajo and Chris' comments.  Never got the shot either.  See if you can speak with a dietician who specializes in helping cancer patients for meal and food recommendations.  

    Also, please keep in mind that ALL medications have possible side effects.  

  • Soup52
    Soup52 Member Posts: 908 Member
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    I'm with severL others. I

    I'm with severL others. I never had to have the shot as my blood counts were always good.

  • TeddyandBears_Mom
    TeddyandBears_Mom Member Posts: 1,814 Member
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    Becca, welcome to the group.

    Becca, welcome to the group. Glad you found us and sorry you had to... Please come back and let us know how you are doing. I hope your treatments have minimal side effects and you sail through them. There is a thread titled 'Ladies Going Through Chemo' where several of us documented our chemo journey that you might find very helpful.

    I only had one Neulasta shot and refused additional ones because it did cause me a lot of pain and stomach issues. Many ladies on this board had little side effects though. My blood counts did tank and I opted to stay home instead of getting the shot.

    Good luck tomorrow.

    Love and Hugs,

    Cindi

     

  • CheeseQueen57
    CheeseQueen57 Member Posts: 933 Member
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    No shots for me

    I also have Stage IIIC2, Grade 3 endometrioid cancer.  I'm heading into chemo #9 this week out of 18.  I get Carboplatin + Paclitaxel.  I get the Paclitaxel every week and the Carboplatin every 3 weeks.  My oncologist said they don't use the Neulasta with this regime.  I was relieved after hearing all the side effects from the Neulasta.  So far my levels have been okay. 

  • ncg007
    ncg007 Member Posts: 138 Member
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    insurance paid

    I had to have Neulasta shot only after rounds 5 & 6 of carboplatin/paclitaxel because my blood levels got extremely low and Blue Cross insurance covered.  You dr may trying to be proactive with giving you the shot from the start.  I would check to see if insurance will cover if the need arises; which I hope you find you never need it.  I too was hesitant of the side effects, but had no issues.  Remember to take Claritin with the shot if you end up getting it.  Wishing you the best outcome with your first round tomorrow.

    Nancy

  • Kvdyson
    Kvdyson Member Posts: 790 Member
    edited June 2016 #11
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    Neulasta After Every Chemo

    Hi Becca, I had a Neulasta shot (Onpro) after every round of chemo. The oncology nurses applied for financial assistance with Amgen (the manufacturer) for me and I was approved. I never received a bill and my insurance was never charged. Hope this information helps! Kim

  • joannewtta
    joannewtta Member Posts: 43
    edited June 2016 #12
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    Kvdyson said:

    Neulasta After Every Chemo

    Hi Becca, I had a Neulasta shot (Onpro) after every round of chemo. The oncology nurses applied for financial assistance with Amgen (the manufacturer) for me and I was approved. I never received a bill and my insurance was never charged. Hope this information helps! Kim

    Stage 3, grade3C UPSC

    Stage 3, grade3C UPSC diagnosed three years ago next week. I had the same course you did of weekly and carbon one week. I also got a week off between rounds

     Six Neulasta shots. I tanked every time I completed the third week. I took Claratin and had no problems. I had to pretty much stay out of public places because my white blood count dropped critically low. I'm doing great and see my oncologist on July. Chemo was brutal but for me the worst part was just being soooooo tired. Insurance paid but it was over$10,000 per shot. I also had two blood transfusions.   

    This Is a great group of women here and you can learn so much. No subject off limits

    Joanne
  • namedropper
    namedropper Member Posts: 102 Member
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    I got a lot of bone pain  ( I

    I got a lot of bone pain  ( I also have RA and Sjogrens ) with the Neulasta shot so they switched me to Neupogen. I had to go a few times a week to get it because it is not as strong as the Neulasta shot but it worked  for me...It also doesn't cost as much.

  • beccabtown
    beccabtown Member Posts: 234
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    Kvdyson said:

    Neulasta After Every Chemo

    Hi Becca, I had a Neulasta shot (Onpro) after every round of chemo. The oncology nurses applied for financial assistance with Amgen (the manufacturer) for me and I was approved. I never received a bill and my insurance was never charged. Hope this information helps! Kim

    Thanks, that is very helpful

    Thanks, that is very helpful information.

  • EZLiving66
    EZLiving66 Member Posts: 1,483 Member
    edited June 2016 #15
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    Just as a side note.  My

    Just as a side note.  My sister worked for Amgen when they were developing Neulasta - she's a microbiologist.  For every batch they were manufacturing, they were losing a gallon (which retails for about a million dollars).  She developed a way to recoup that gallon and received a commendation AND a really nice bonus (enough to buy a car).....so, yes, this stuff costs about $10,000 a shot which is crazy - even she thinks it's crazy and she usually defends the high price of drugs since she sees all the things they have in the hopper that never even make it to testing.  

    Love,

    Eldri

  • ConnieSW
    ConnieSW Member Posts: 1,680 Member
    edited June 2016 #16
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    Sister's work

    that is really cool, Eldri.

  • pinky104
    pinky104 Member Posts: 574 Member
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    Skipped Neulasta

    I declined the Neulasta shot.  My little brother had a heart attack the week before I was supposed to have my first shot, so there was no way I was going to have a shot of something that had a risk of causing a heart attack in me.  It's a good thing I did skip it, as I was diagnosed with hemochromatosis 3 months after chemo, and that can also cause heart attacks. I probably would have doubled my odds of having one.  My blood counts did go down during chemo.  I got almost constant UTI's and was very pale.  I was given a transfusion halfway through my 6 rounds of chemo, which was supposed to make me feel better, but didn't, probably because of the hemochromatosis. After reading many posts on here about people needing to take Claritin to get rid of the bone pain caused by Neulasta, I've been very glad I didn't get the shot.  In late September, I'll be 6 years out from chemo for my stage IVb UPSC.