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Insurance co. denies Neulasta

beccabtown's picture
beccabtown
Posts: 234
Joined: May 2016

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.

EZLiving66's picture
EZLiving66
Posts: 1479
Joined: Oct 2015

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's picture
debrajo
Posts: 1095
Joined: Sep 2011

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's picture
Editgrl
Posts: 903
Joined: Jun 2015

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's picture
beccabtown
Posts: 234
Joined: May 2016

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

NoTimeForCancer's picture
NoTimeForCancer
Posts: 2913
Joined: Mar 2013

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's picture
Soup52
Posts: 906
Joined: Jan 2016

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

TeddyandBears_Mom's picture
TeddyandBears_Mom
Posts: 1802
Joined: Jun 2015

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's picture
CheeseQueen57
Posts: 936
Joined: Feb 2016

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
Posts: 136
Joined: Nov 2015

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's picture
Kvdyson
Posts: 789
Joined: Jan 2016

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's picture
joannewtta
Posts: 43
Joined: Jul 2014

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

beccabtown's picture
beccabtown
Posts: 234
Joined: May 2016

Thanks, that is very helpful information.

namedropper
Posts: 102
Joined: Dec 2014

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.

EZLiving66's picture
EZLiving66
Posts: 1479
Joined: Oct 2015

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
Posts: 1576
Joined: Jun 2012

that is really cool, Eldri.

pinky104
Posts: 574
Joined: Feb 2013

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.

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