Red Blood Cell Booster

[tousled1]

For anyone on Medicare you might be interested to know that Medicare has changed the standard for authorizing shots such as Procrit to boost red blood cells. Your hemobglobin now has to be 10 or below in order to receive the shot.

[Mary Jo]

Insurance..................what a racket!!!!!!!!!!!!!!!!!!!!!!!!!

Mary Jo

[StephN]

Ten or below - EVEN if you are in a clinical trial with different standards??

In other words, "NO exceptions?"

In that case I don't think I would have made it through my last chemos to get to NED with that lower standard.

This bears some looking into for those on Medicare who might need those shots - the oncs need to be in on that as well.

[tousled1]

Steph,

I plan calling Medicare as this greatly affects me. I just went on Medicare in March and still have my United Health Care as my secondary. Even so I have to wait until my count goes to 10 or below. I would have never made it through my chemo before with the help of Procrit as my coiunts drop very quickly. Yesterday, my count was 11.1 and that was just after 2 treatments. Guess, I'll be dragging myself into the office or else to the ER for a blood transfusion.

[fauxgypsy]

Does this apply to Medicaid as well? I also want to know how to find out what they are basing this ruling on. Does anyone know how to find this out? Surely , it can't just be arbitrary.

Leslie

[tousled1]

As usual, it's a cost saving thing. And I'm sure Medicaid is also affected since both Medicaid and Medicare are government programs.