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Thread: prescription process- the path from the Dr to the Pharmacy

  1. #11
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    Default Re: prescription process- the path from the Dr to the Pharmacy

    First, I want to thank you all who have responded with ideas and encouragement. After twenty years of chemotherapy, illness , pain and prednisone (yes, for the ENTIRE time I have had all of this going on .EVERY day. ) I have no friends left. People want to talk about the normal and positive things in life (as do I myself) and get 'friend fatigue' by someone who doesn't just get better and move on with things. I very much try and move on with things but I'm dragging this lead weight of all these things.

    So, an update on the prescription written several weeks ago for a Rituxan infusion. A new twist has emerged that I have never encountered before. I talked with the insurance company and they have denied the request for 750 mg Rituxan infusion. They say they would APPROVE a 500 mg infusion. I asked the VERY helpful insurance rep "This is new to me. Does this mean the insurance company has a doctor that looks at the request (and my situation) and is disagreeing with my doctor just on the dosage?"

    She says "Yes, there is a panel of doctors who look over the request and they are suggesting the lower dosage. "

    I called my doctor and talked to his very pleasant and helpful office person and she said that they had also received this information and it might be a week before my doctor can look it over and I will hear back. I told her "I have already been waiting several weeks to begin this treatment" . She said she knew that but it still might take that long to go through their process.

    I told her that I trust my doctor completely to make this decision for me but that I myself would be ok with the lower dose- but only if he thinks it is ok. Ironically, I MYSELF was hoping to do a lower dose. My antibody count is below the normal range. I think I would do well with a low dose- but I'm aware that I don't have the extensive experience that my doctor has. I actually, truly, trust him to be making what he thinks is the best decision. If he and I could talk I know he would explain his ideas behind the dose choice.

    So, I am taking all of this as PROGRESS. I am actually approved to get the Rituxan and it is only left up to working out the dose. Some day, I hope to come back and report what I have learned about how Rituxan doses are decided as I literally know nothing about that is done. I am curious as to what an absolute minimum dose is and what the logic is behind it.

    Thanks again for those of you giving my your time with encouragement and ideas.

    Oh, and VDub . I understand what you are saying about the cost. If they are talking about it all they have not mentioned it to me. It truly seems like they are just considering what is the best care for me- which is a bit surprising to me too. Also surprising is that the insurance company has been so helpful and kind. One person put me on hold recently and called the Dr office on my behalf. Soon after that I heard from the doctor's office. She wasn't just 'doing her job' she actually cared that I was 'getting the run around' and wanted to help me. A reminder to me how important just one person can be.

  2. #12
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    Default Re: prescription process- the path from the Dr to the Pharmacy

    You are so right about people fading away. When I was diagnosed my husband reminded me of when his brother was diagnosed with a brain tumor. He was a fun loving, kind and popular person. By the time he passed away (2 years) almost eveyone had faded away. But what is most hurtful is that before I was sick, I was attentive to so many peoples ailments. I cooked and delivered many meals, sent cards, visited. Not one person has done it for me. My neighbor tells me at club meetings they ask about me. One person actually said ‘tell Masha we love her.’ Thank goodness for the wonderful people at this site. We have walked a mile in each other shoes.
    I sure hope hey hurry up with your Rituxin. I have to wonder if any of the doctors on the board deciding your case uwould feel if they had ever gone through the pain we go through.
    Masha

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  4. #13
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    Default Re: prescription process- the path from the Dr to the Pharmacy

    Thanks Masha. I have wondered the same things.

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    Default Re: prescription process- the path from the Dr to the Pharmacy

    At least you found something out. That's great!
    Wegener's (​GPA )- dx Apr10, Granulomatous Hypophysitis - dx Apr10, Diaphragmatic Paralysis - dx Feb16, Bradycardia - dx Dec16. (my story)
    Forum Member Map -- world map for you to put a stickpin of where you are located....

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    Default Re: prescription process- the path from the Dr to the Pharmacy

    It is hard to read about that things that impinge upon us Weggies getting good care and not have a strong visceral reaction. It is hard for me not to be skeptical about the motives of insurance company doctors reviewing your care. I have known some very bad doctors who went to work at insurance companies just to deny coverage for the patients in order to save the company money. The job was find any excuse they could to deny a claim.

    But I too have had some very good experiences with reps from my insurance company who have spent hours on the phone with me and calling vendors to help me get the supplies I need to help manage my diabetes. They have gone the extra mile and seem to radiate genuine concern for my welfare. It is a great feeling when you have those encounters since getting good health care today is often a crap shoot with a lot of frustration at times and great feelings of relief and joy when you get really good care and help, especially when it literally saves your life.

    It is nice we have this forum to help support each other even if some times we just pool our ignorance and frustration but often we get some great pearls of wisdom and sage advice.
    Knowledge is power! Wisdom is using it to make good decisions!

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    Default Re: prescription process- the path from the Dr to the Pharmacy

    I DO appreciate your responses and your concern.
    Last edited by me2; 01-15-2020 at 01:52 AM.

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    Default Re: prescription process- the path from the Dr to the Pharmacy

    Update - 33 days after being prescribed Rituxan I now have an appointment to get the infusion- and a notebook of notes almost an inch thick. I need to just de-stress and get ready for the 5 hour drive to the clinic tomorrow. Thanks for everyones input and encouragement.

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    Default Re: prescription process- the path from the Dr to the Pharmacy

    Quote Originally Posted by me2 View Post
    Update - 33 days after being prescribed Rituxan I now have an appointment to get the infusion- and a notebook of notes almost an inch thick. I need to just de-stress and get ready for the 5 hour drive to the clinic tomorrow. Thanks for everyones input and encouragement.
    Hope it goes well for you!
    Knowledge is power! Wisdom is using it to make good decisions!

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