The Prescription

The call came before I had poured my first cup of coffee, but I promptly answered since I had been waiting for it for several weeks. The voice on the other end of the line was polite and professional. I laughed nervously as we exchanged pleasantries. She was from the specialty pharmacy, and she had my fate in her hands.

You see, the last time I completed chemo, I had gleefully celebrated my remission status. I firmly believed that I was done, finished, cured. I naively thought that my biggest challenge in the months and years ahead would be growing hair and losing the steroid weight. I was wrong. So this time, when my doctor suggested a maintenance drug, a parp inhibitor that offered the possibility of keeping the beast from returning, I readily agreed to try it.

The oncology nurse had carefully reviewed the long list of side effects with me. I was asked to sign an acknowledgment that I understood the risks. But as I have learned in this life, rewards must be weighed against those risks, and having a chance to stay cancer free is worth it to me. Besides, I figured, as long as I didn’t grow a beard or a tail, as long as my ears didn’t fall off, I would handle it.

I had already been forewarned that it would take a few weeks for the paperwork to be processed and submitted to insurance because it was a pricey drug. I took a deep breath before asking the question. Sometimes, curiosity isn’t a good thing. Just ask Pandora.

“How much IS it?” I asked.

“Twelve thousand a month for your dosage.”

“I’m sorry,” I said, “I thought you said ‘twelve grand.’”

“I did. And yes, I know. It was hard for me to believe, too.”

Even without a calculator I was able to do the quick multiplication. I had been prescribed a potentially life-saving drug which cost $144,000 a year. My mind raced over the implications, the scenarios of all the things I might buy with that kind of money. A small house? A luxury car or two? An around-the-world vacation, first class? I thought of the good I would be able to do with that amount of cash. How many hungry children could I feed? How many college scholarships could I give away? Of course, it was all a bit of fantasy because such a sum was pie-in-the sky unrealistic for me. And this drug might also be out of reach financially, I quickly realized.

I began to speculate about copays. If my insurance agreed to approve it and bore the majority of the cost, it could still be exorbitant. Even at ten percent, it would cost $1200 a month, or $14,400 annually, which was still not feasible.

I did some research and discovered that because of a complicated qualification system, I wasn’t eligible for assistance from the drug manufacturer, nor could I realistically use any coupons or discounts. I also learned that many women, even those with decent coverage, have a difficult time paying for it because of its exorbitant price. This, along with inflated hospital costs, is why insurance premiums have skyrocketed, making the cost of medical care prohibitive. It is disconcerting, for all of us.

Let's face it: so much of battling this disease is out of my control, which often makes me feel helpless. I hate that part most of all. I tried not to worry, which was easier said than done.

I stumbled across an article this week based on an interview with the CEO of a major pharmaceutical company. His corporation had been buying the expired patents of many common drugs and selling them on a proprietary basis for five hundred times what they had been just a few years ago. Meanwhile, the new drugs, based on breakthrough research, are being marketed and sold at record- breaking prices. And as a result, the patients struggle to afford them, especially those who are underinsured or uninsured. When asked if he felt a moral obligation to people who were ill, his reply was ruthless, but straightforward. “I am in the business of making money for stockholders, not to heal anyone,” he said. Quite frankly, by the time I had finished reading the article I felt a little sick myself.

I know that cancer is big business. My course of chemotherapy this time cost well over $500,000. And that was for six triple infusions, the accompanying medication, and regular bloodwork. I certainly didn’t pay half a million out of pocket, but these two years of fighting the disease has taken its financial toll, even with good insurance. Now, this new phase of treatment also comes with a hefty price tag.

And so, I had nervously waited the four weeks for that phone call.

“What is my copay?” I asked almost immediately.

“We will get to that at the end of the interview,” she said, her voice practiced and courteous.

“You should tell me that now in case there is no need for an interview,” I said.

“Let’s see,” she said, pausing to look for the information. I held my breath. “Your part will be $84.50 per month.”

I exhaled, then asked her to repeat it, which she did. I began to cry with relief, loudly wailing into the phone. “I’m so grateful,” I mumbled between sobs, unable to say much more.

And for a moment there was a crack in her serious demeanor as she whispered, “I am happy it worked out for you. You have made my day.”

This time, I am one of the lucky ones, and I know it. Some are not as fortunate, which makes me sad. And I am ever so thankful to be given a chance to fight this beast with the newest drug available.

God is good. Always.

And yes, I’ll let you know if I grow a tail.