[Bill]

Dana, this brings back alot of memories. I'm not going to spend alot of time editing and trying to write a smooth-sounding tale here, just the facts as best as I can recall. Nikki and I had Anthem/BCBS and her onc. prescribed Xeloda and it was denied. I began buying it out-of-pocket after a few days while we appealed, and at the same time, Nikki was in touch with Roche. Our NP had told us that the pharm. companies will often cover the cost of meds. in hardship cases. At the same time, our onc. was contacting Anthem and trying to find out why the Xeloda was denied. It turned out that Anthem only covered Xeloda if the patient was on a Taxane and it had failed (patient showing progression). Has Kim been on a taxane and showed progression? I'm assuming so. We were paying over 200 dollars a day for six pills/day. Scary math, but what can you do? I went to the pharmacy daily and got her six pills, each day hoping for good news from somebody. After about a week and a half, the representative from Roche said that they would donate the meds for Nikki! Almost on the same day, our onc. was able to convince Anthem that all other treatments had failed and Nikki needed the Xeloda. It was approved. Nikki called the Roche rep. back and told her that our insurance would cover the Xeloda and thanked her. The Roche rep. was insistent that if there was any problem whatsoever with our insurance that Nikki should call her back. They were willing to help. I wish I had gotten her name. Nikki was so impressed with her. She must become "the Warrior". Attack this problem from all directions at once. Call the pharmaceutical companies daily. Enlist the aid of her oncs. and NP's and chemo. nurses and everyone who will listen. Her advocates and friends need to tell anyone pertinent to the situation her story. When I went to the pharmacy, I told Nikki's story to all of the pharmacists and techs., and enlisted their aid, not conspiratorially, of course, but most people want to help. The Xeloda was denied. "I'm sorry sir, the prescription was denied." "Run it through again" "Denied" Go back every day and run it through again as many times as you can. You must be patient, though, at the same time, with your pharmacists and techs. behind the counter. They are your allies in the battle. I donated all of Nikki's meds. to a facility and they were used. I'm sorry about the rambling.