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Neulasta reimbursement after 72 hrs (Medicare)?

Evarista
Posts: 268
Joined: May 2017

Currently on Round 6 of R-EPOCH for DLBCL.  I have mostly gotten my prior Neulasta injections within 72 hrs of finishing chemo.  Because of the holiday Monday, I have to have it early (24 hrs) or late (>72 hours).  However, I've been cautioned by my "team" that Medicare is unlikely to reimburse if given >72 hrs after finishing. Since this stuff is not cheap & falls under Part B (no deductible?), we don't want to make that mistake.  However, while I can find lots of info (including at CMS/Medicare) about the "No sooner than 24 hrs after chemo" and reimbursement, I find absolutely nothing about reimbursement after 72 hrs.  Also, I cannot tell if "72 hrs" is a rough day-to-day count (e.g., Sat, anytime-to-Tues, anytime) or a precise 72 hr count (Sat, 2AM-to-Tues, 2AM). Does anyone have direct experience with this issue or know of a link that would clarify?

Since I nadir very deeply, we've found that pushing the Neulasta to as late as possible prevents extremely low WBC & platelets, which is why I'm concerned about the timeing. Thanks!

lindary's picture
lindary
Posts: 663
Joined: Mar 2015

When I did R-Chop and later with RICE, I had the neulasta 24 hours after the treatment ended.

On tv there have been ads about Neulasta Onpro. It is put on the arm and automatically delivers the drug.  At least that is what I get from the tv spot. 

 

Evarista
Posts: 268
Joined: May 2017

Thank you for the feedback.  My problem is that 24 hrs is too soon &  >72 hours may be too late (for Medicare).  The OnPro (as I understand it) would go on when chemo finishes and inject 27 hrs later.  So still too early for my particular rapid Neulasta response.  We shall see what happens.

Sandy Ray's picture
Sandy Ray
Posts: 97
Joined: May 2017

Just to share my experience. My WBC were dropping 7 days later than expected. On RCHOP they expected day 7 but mine keep bottoming out on day 14. I got the Neulasta Onpro and thought 27 hours was to soon since my counts dropped so late. When I had my blood test at 7 days it was no different than when I had not received Neulasta so I thought there you go this is not going to work. Well on day 14 they were up up up just as needed.

So despite my doubt and even though my counts seem to drop late it worked. Now that is after my 3rd treatment. I have received the second Onpro after treatment 4 and have blood test tomorrow which will be day 7.

The first 2 treatments the counts dropped week 2 and I had Neupogen shots on day 14 I had 2 shots and day 15 I had one shot and by day 21 I was ready to go.

Hope things go well for you!

Max Former Hodgkins Stage 3's picture
Max Former Hodg...
Posts: 3327
Joined: May 2012

Evarista,

What I recall about Neulasta is that it should not be given to anyone within 24 hours after an infusion, since the chemo would somehow neutralize the Neulasta itself.  I always got my infusions on Fridays, and always went back for Neulasta on Monday mornings, and it worked gangbusters -- so well that the first shot caued me extreme back pain, and later doses had to be cut in half, but even at half-dose given on Mondays, it kept my WBC high -normal  (I have a broken back and 2 collapsed disks, which is what allowed the pain to get out of hand).

There is an older variant of Neulasta still common today (Filgrastim) , which operates slightly differently; I forgot the particulars, but will post a link. It is self-administered at home, sometimes daily.  Your oncologist would have to fine-tune dosing to your particular case.

http://chemocare.com/chemotherapy/drug-info/Neulasta.aspx

http://chemocare.com/chemotherapy/drug-info/filgrastim.aspx

Evarista
Posts: 268
Joined: May 2017

That sounds like ~72 hours later, so it's good to hear (assuming Medicare/insurance picked up).  I was physically unwell enough to make a 24 -36 hr window, so ended up at almost exactly 72 hrs post-infusion.  We will find out eventually how Medicare views this.  Again, internet searches turned up a whole lot of links to the "Don't do before 24 hrs post-infusion" conditions (both medical & insurance, as you point out), but zero on any rules referencing >72 hrs.  

So, done for now, fingers crossed on the no-bone-pain wish, and will definitely try to post back when the billing gets sorted.  Thanks all.

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