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Lost Chemo money
Old 06-07-2015, 10:50 AM   #1
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Lost Chemo money

I have a question, that perhaps might find an answer here. My MIL began chemo therapy for her stage 4 lung cancer. The chemo cost them $70,000 out of pocket for the first month. That was jaw-dropping enough, but then they found that she reacted very poorly to the chemo, so she had to stop taking it after the first few doses. They now have her on some other form of chemo. So they simply lose $70,000? Is there anything they can do to recover some of the money (besides the tax writeoff)? Thanks for any insight.
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Old 06-07-2015, 10:52 AM   #2
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$70k out of pocket No insurance?
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Old 06-07-2015, 11:07 AM   #3
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I don't think healthcare works like that. All treatments have unwanted consequences and chemotherapy is notorious for causing severe side effects (after all, it's glorified Drano which destroys everything in its path). Expected effectiveness, side effects, and cost should have been part of the informed consent discussions prior to starting chemotherapy. Of course, if none of that happened, MIL could sue.

The out of pocket cost you mention is staggering. But that's another story.
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Old 06-07-2015, 11:11 AM   #4
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$70k out of pocket No insurance?
I just checked with them- they wouldn't say how much was out of pocket, but the amount was "alot". I just wonder if they should approach the drug company and ask for some sort of refund. I can't imagine the drug is that expensive to manufacture, but they are trying to recover R&D costs, and charge what the market will bear.
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Old 06-07-2015, 11:16 AM   #5
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Not directly related to the question of obtaining a rebate, but in the same direction. Some recent background information on the subject.

New Push Ties Cost of Drugs to How Well They Work - WSJ

It outlines some progress in relating medical success to patient costs.
The general subject would seem to apply to any recommended medical procedure... from knee replacement to open heart surgery.

Wish you the best in obtaining some relief. The dollar amount is certainly worth challenging.
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Old 06-07-2015, 11:20 AM   #6
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So sorry for your MIL. Hope she does better with the next drug of choice.
Agree with Meadbh, this should have been part of the consent process.
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Old 06-07-2015, 11:21 AM   #7
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Not directly related to the question of obtaining a rebate, but in the same direction. Some recent background information on the subject.

New Push Ties Cost of Drugs to How Well They Work - WSJ
Good link- thanks
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Old 06-07-2015, 07:59 PM   #8
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Tough call on stage 4 cancer.

I have known eight people with stage 4. In all cases the the chemo caused more pain and suffering than palliative care would have. AFIK stage 4 chemo treatment buys a minimal amount of time at maximum cost in $$$ and creates a miserable existence for the remaining time.

One friend just put up with lung cancer until the very end, refused treatment save for pain management, drove himself into the hospice where he died three days later.

Both DW and I have agreed long ago, should either of us be diagnosed with cancer - no chemo and no radiation.

In fact DW had lung cancer. She told the doctors immediately upon diagnosis NO chemo or radiation. It turned out to be stage 1. Determination was made on the staging after part of her lung was removed and analyzed in the the lab. One half of one lung lobectomy IIRC four or five years ago. She had no recurrence. I made a post on the subject on this board at the time, don't feel like dredging it up at the moment.

The original agreement remains, under no circumstances will we undergo chemo or radiation.

Having said all of that one friend of ours is currently undegoing chemo. Unfortunately he is slipping fast and is miserable. We do not meddle or counsel others on what to do with their life. Do assist to help him and his wife cope.

What disturbs me most is that treatments are assigned without first providing factual evidence that a particular cancer drug is effective for that particular person's cancer and that it will not kill him or her first.
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Old 06-07-2015, 08:40 PM   #9
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I don't know that I would say 100% no to chemo. I have stock in a company (Endocyte) who are working on a new way to deliver chemo drugs to specifically cancer cells. They tie the really deadly chemo drug to a ligand that is mostly absorbed by tumor cells. When inside the cell it releases the drug and destroys the cell, leaving the rest of the body in good shape. The new 1456 version totally destroyed tumors in mice.

If it works, the 2000 shares I bought at $5.50 will be worth enough to pay for 3 or 4 $70,000 treatments. I actually just hope it works for all of the good it could do for cancer patients.
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Old 06-07-2015, 09:23 PM   #10
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I don't know that I would say 100% no to chemo. ....
And some of the radiation treatments are very targeted, and sometimes with very few/no side effects.

I understand what is being said, and I lean that way myself (quality of life is the key for me). But I would not 'just say no' - I'd want a good understanding of the situation.

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Old 06-07-2015, 09:27 PM   #11
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IMHO- There's a huge difference between medicine saving a life vs prolonging death.
When faced with chemo, radiation, etc., I would ask very blunt and direct questions about expected treatment outcomes (expected life expectancy, side effects, etc.) vs observation and comfort care. Some cancers (depending on how advanced) now can be cured by chemo &/or radiation. But too often very expensive chemo/radiation/surgery for advanced cancer offers little promise of more meaningful life (median survival vs watching) but at the risk of major side effects. Why not live the time you have left to the fullest rather than spend it recovering from major treatments which, in too many cases, might prolong ave survival by few weeks (if at all)? IMHO- It is about maximizing MEANINGFUL life, not just how long they can keep your heart beating.
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Old 06-08-2015, 05:42 AM   #12
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Last ditch effort treatments for stage 4 cancers do not work that well.

And side effects and efficacy of chemo drugs vary from patient to patient, yet they still have no way to determine these beforehand. All they can do is to try the drug and see what happens.

In a few isolated cases, a drug hideous side effect on a patient can be determined by a genetic test. Would be nice if we can determine beforehand which drug will work on a particular patient.
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Old 06-08-2015, 05:51 AM   #13
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From: https://www.healthcare.gov/glossary/...maximum-limit/

Quote:
"The maximum out-of-pocket cost limit for any individual Marketplace plan for 2015 can be no more than $6,600 for an individual plan and $13,200 for a family plan."
If, on the other hand, MIL was on Medicare and did not maintain a supplemental policy to cover the unbounded 20% copay then Medical expenses could get expensive.

A lesson to us all.
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Old 06-08-2015, 08:16 AM   #14
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...

In a few isolated cases, a drug hideous side effect on a patient can be determined by a genetic test. Would be nice if we can determine beforehand which drug will work on a particular patient.
This was the case with a family member. He responded very well to the medicine, but as time went on (days, weeks?), he became very sick. Turned out he lacked one of the genes that metabolizes that med, so it built up in his system (might be why it worked so well?). Apparently, there are two genes for this, and some people lack both. I think they just gave it time to work out, and then continued on a smaller dose. He is doing well now.

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Old 06-08-2015, 08:52 AM   #15
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But too often very expensive chemo/radiation/surgery for advanced cancer offers little promise of more meaningful life (median survival vs watching) but at the risk of major side effects.
That's all true. But averages are just that. In the cases in which I've been directly involved, in 2 of 3 cases the patients wanted to take treatment in hopes that they would be one of the very few to benefit.
So many issues and emotions. And often at the time of diagnosis, people haven't come fully to grips with their own feelings: What they "owe" each other, what other family members expect, what it really means when the doc says "you'll feel ill", and what starting hospice/palliative care means.
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Old 06-08-2015, 11:01 AM   #16
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That's all true. But averages are just that. In the cases in which I've been directly involved, in 2 of 3 cases the patients wanted to take treatment in hopes that they would be one of the very few to benefit.
So many issues and emotions. And often at the time of diagnosis, people haven't come fully to grips with their own feelings: What they "owe" each other, what other family members expect, what it really means when the doc says "you'll feel ill", and what starting hospice/palliative care means.
In some conditions, evidence suggests hospice patients may live LONGER than under 'standard' medical care.
Comparing hospice and nonhospice patient survival among patients who die within a three-year window. - PubMed - NCBI

Including some lung cancers-
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Old 06-08-2015, 02:27 PM   #17
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In some conditions, evidence suggests hospice patients may live LONGER than under 'standard' medical care.
Comparing hospice and nonhospice patient survival among patients who die within a three-year window. - PubMed - NCBI

Including some lung cancers-
MMS: Error
Thanks, those were interesting. I wish the abstract of the first study had told us the % of patients who refused all care (standard or hospice). Still, I'd guess that number is relatively small.

FWIW, my experience with hospice care was very favorable. It not only was good for the patient it was especially good for the well being of the spouse of the terminal patient. She, and the whole family, got terrific and timely support whenever (day or night) they needed it.
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Old 06-09-2015, 01:39 AM   #18
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... Turned out he lacked one of the genes that metabolizes that med, so it built up in his system (might be why it worked so well?). Apparently, there are two genes for this, and some people lack both. I think they just gave it time to work out, and then continued on a smaller dose...
I read of a drug that affects about 1% of the population. While the half-life of the drug in the bloodstream is normally in the order of a few hours, some people lack the enzyme that metabolizes it. A single dose can be fatal, if an antidote is not administered in time.
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Old 06-09-2015, 01:46 AM   #19
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... In the cases in which I've been directly involved, in 2 of 3 cases the patients wanted to take treatment in hopes that they would be one of the very few to benefit.
So many issues and emotions...
The survival instinct and the will to live are very strong. One cannot be sure how he reacts until he faces down the choices himself. Unless one expires from a sudden cause such as a cardiac arrest, people will age and deteriorate to a point where medicine cannot really help. So, we should all be thinking about this.
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Old 06-10-2015, 11:20 PM   #20
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The chemo cost them $70,000 out of pocket for the first month. That was jaw-dropping enough, but then they found that she reacted very poorly to the chemo, so she had to stop taking it after the first few doses.
Something to consider for future encounters with OMG expensive meds. The aggressive 'over test and over prescribe' approach of Thai doctors has taught many expats to just say no to buying the full course of a medication (excluding antibiotics) when the cost is non-trivial. I buy a week's worth to evaluate the side effects.

Unless the chemo substances are in short supply or manufactured on demand, why wouldn't this work in the US of A?
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