From Patient to Profit Center

Turns out CVS Caremark has found a cure for cancer: induce a heart attack so there’s no fear of succumbing to the deadly disease.
This was Britany’s quest, I’m sure, when she called me to tell me my new prescription had arrived.

Ibrance, the new drug I’ve been prescribed, is just out of development, giving it a hefty price tag. I can’t purchase it any longer at my local pharmacy, where I have compassionate friends. I now need to go through a health-insurance appointed specialty pharmacist. I should be grateful that I’m getting an actual live person to call me, rather than an automated recording to deliver me this news. Shame on me, I’m no

 HELL TO PAY

“There’s a 70 percent co-pay,” Britany announces matter-of-factly and slightly annoyed.”That amounts to $4,380.”
She pauses, waiting for a shriek. When I don’t comply, she adds, “That’s a month.”
“You do realize this is a life-saving medication?” I reply, brittlely and equally annoyed, even though I feel a hot wave of fear wash over me, tying a knot in my intestines where Britany’s bombshell has gone off.
“Well there’s a number I can give you to call Pfizer for co-pay assistance,” she says.
I grab a pen and she rattles off the number.
“If you’re accepted, call me back,” she says, ready to sign off. I can’t see her, but I can feel her reach to disconnect the call.
I get that Britany probably makes only $10 an hour and has problems of her own and that while her job is obstensibly to make phone calls, in truth, it’s to drop bombshells into the laps of the dying or nearly dead and then walk away, without concern. That takes a great deal of desensitization, which I should have empathy for, if not a degree of awe.
“Is there a number I should call you at?” I ask before she’s able to finish the task.
“Oh yeah,” she says, then rattles off another 800 number. She knows that we will likely never speak again. Still, I can hear in her voice a slight change that says “Oh, this one isn’t the walking dead only the slightly dead. Maybe she’ll have a chance.”
I immediately dial Pfizer, realizing that Britany has delivered me this news after hours and there’s a good chance no one is around. During a 20-minute, nail-biting, Muzak infused on-hold wait ,  I realize how much I already miss my local pharmacist and consider running down there to load up on anti-nausea medication to get through the remainder of my life if this is any indication of how it’s going to go. Finally cheery Ian answers. I tell him about my conversation with Britany. He’s happy to oblige me and directs me to an insider Web site where I can immediately apply for assistance.

THE $4,380 QUIZ

It turns out, there’s a three-question quiz, which I pass. I tell Ian I can take it from here, as the next screen just asks for information so it can print me a copay card. I tell Ian he’s saved my life and wish him a winning lottery ticket in return. This makes Ian even cheerier.

I fill out all the two-starred fields required, but the Web site won’t accept my submission. The panic returns. A carrot dangled in front of me. I call Pfizer back. Gratefully, the call goes through immediately. This time I get David, whose a bit more somber than Ian, but equally eager to help. We go through what I’ve done, what I haven’t done, what’s checked,  what isn’t, what the screen says, what it doesn’t say. He finally diagnoses the problem as the laptop I’m using.

“You’ll need a desktop computer,” he said.

“You do realize desktops are obsolete, that no one has them any more?” I answer.

“Well try your phone.”

“I don’t have a smart phone,” I say, realizing that technologically I’m stuck in no-man’s land. No longer an archaic desktop user and not yet hip enough to have a smart phone.

I do, though, have another laptop. I can’t really explain why, other than for situations like this.

“Wait,” I say. “Let me try another computer.” I quickly load the site, pass my three-question quiz, update the two-starred registration fields and voila, I’m accepted. I get a card.

I wish David a winning lottery ticket as well for saving my life.

LIVE-SAVING MEDS TAKE A LIFETIME IN CVS CARLESS’S TIME ZONE

I call back CVS Caremark a bit amazed that I’ve been able to accomplish a $4,000-plus-a-month savings in an hour’s time. Where’s Britany now? I get another David, who has all of Britany’s suave and sensitivity.

“Your address?” he says.

I rattle it off. There’s a long pause. He doesn’t explain. Finally, he starts asking me for numbers on the copay card. The knots in my intestines start to loosen.

David isn’t a fast typer, I learn. When he finally gets all the information he needs, he informs me that it could take up to 72 hours for CVS Caremark’s oncology team to input the information. I’m afraid to ask, isn’t that what he just did? Instead I say,

“You do realize this is life-saving medication?”

“I’ve marked it rush,” he says, in his monotone voice.

“But there’s no guarantee?” I offer.

“Precisely,” he says.

Still, I wish him a winning lottery ticket and thank him for his effort in saving my life. I know it’s dramatic, but he needs some sort of shot in the arm, an “Atta Boy!” at least.

When I hang up, I realize that this is the “mixed bag” my doctor spoke of at my last appointment. I have gone from patient to profit center. Yes, there are many promising drugs, tests, protocols and procedures for those of us with cancer. And all of them come with a huge price tag that everyone wants a piece of, from the drug companies to the health insurance companies, from the specialty pharmacists to the hospitals. If I expect to survive, I need to harden myself and brace for this roughshod treatment.

DEATH PROFITS

I look up the cost of a share of CVS Caremark. It’s trading at $102. I think about buying it, knowing that CVS Caremark won’t listen to my concerns as a profit-center, but might as a shareholder looking to reap a profit. Finally, we’ll have something in common.

The Unbearable Lightness of Being

Interval healing. That’s what my scans revealed.

I’m still trying to figure out what it is or maybe where it is. Somewhere between not where I want to be and not where I’ve been. Yet heading in the right direction.

It’s still a place of uncertainty, although  I realize, no matter where I go any longer, uncertainty is a certainty.

My doctor and my body are like my childhood Magic 8 Ball these days in their cryptic analysis: Outlook cloudy, try again later.

What did I want my scans to reveal? What would make me happy? Something definitive. Something numeric. An upward number or a downward number. Scans, though, are read by radiologists who write about what they see and then their “impression.” Somehow impression doesn’t sound definitive. It sounds very Magic 8 Ball.

My doctor looks worried (although a nurse reminds me he always looks worried, so you can’t go by that). I ask him what it means. He shuffles papers, pulls out a few snippets from the radiologist’s report, then hands it to me. I realize he hasn’t really read it. That’s why he’s worried. He’s a student caught without having done his homework.

I take the report and start reading my own snippets. “Healing response.” “Interval healing.”

“This sounds good, right?” I say.

He looks at his computer, then at me. “Well, yes,” he says. “But we’re still going to change meds.”  He goes on about biochemical changes as a way of justification. I nod in agreement, even though I know at this moment we’re not quite on the same page about what’s going on inside my body. It’s nothing I can put my finger on. It’s like a piano key slightly out of tune.

When I ask what the radiologist means when he writes the tumor is “filling in” I realize that healing is a new world, with different rules, different terminology that I still don’t quite understand. That I still haven’t distilled meaning from.

The corpses of dead cancer cells build up, making the tumor seem denser or “filled in.”  He calls them blastic. I call them blasted. Either way, they are more dense than the living, breathing, pernicious cancer cells. Death is heavy. Life is light. And the unbearable lightness of being, I discover, is trying to make sense of where the balance lies. This is the weighty process of healing. It’s interval healing.

It’s where I imagine the Syrian refugees live. Out of the reach of an annihilating government and warring terrorists and yet still in search of a final safe haven. Still living in the clutches of uncertainty. Still looking to a Magic 8 Ball for answers in a senseless world that offers none.

Later, a nurse goes over what it will take for me to transfer over to new meds. Life saving meds. Expensive meds.

She’ll need to get an authorization from the insurance company. There may be a fight. There will be lots of paperwork. The doctor will have to justify the change of course. It could take days, maybe a week. We’ll have to wait and see.

I ask her about blastic cells and get a different answer then the one the doctor gave me. I realize I’m going to need a course in microbiology to figure out the answers I’m looking for. Maybe a course in miracles as well.

We seem to be miles apart in our concern about my interval healing and the headaches it’s about to bring.

All we’re able to agree on at the moment is the uncertainty.