neupogen

[maueenh]

My father completed week 1 of Vidaza on Tuesday and went for his weekly Procrit shot yesterday and his counts were so low. WBC 1.5 RBC 2.60 Plat 55 The Onc started him on Neupogen 480mcg and wants to give him an injection on Monday and Tuesday. I just called my mom and she said Dad is so……….tired and breathless when walking up the stairs. Is this normal? It’s only been three weeks since his dx and this is all happening so fast (his decline). He is so tired of drs since he’s been to the hospital everyday for the last week and a half for vidaza then procrit etc I’m concerned that if he’s feeling badly he won’t say anything since he knows we’ll call the doctor. He asked me to just leave him be for the weekend. Just another note..he had a severe bout of constipation on the 6th day of vidaza but never said anything until my mother found him in pain in the bathroom. I feel so helpless.
Maureen

[patti]

Maureen,

Breathlessness can be an indicator that he’s low on blood and maybe needs a transfusion. It’s certainly something to check into. You might check with your doctor about your dad giving himself his shots at home. In January when the prescription drug program started my MIL was able to start giving herself neupogen shots at home. I believe the same can be done with procrit. It might be worth checking into if it would save him many trips to the doctor/hosp.

It’s normal for counts to drop with Vidaza so he may need more supportive care until his counts come back.

Take care.

patti

[eve]

maureen

constipation is a major side effect of vidaza

my dad takes metamucil when he starts treatment to help counteract this problem – and then sometimes a mild laxative like ducolax (sp?) – let your dad ask his doctor what he suggests

he should also mention to the doctor the shortness of breath – my dad tries to stay downstairs all day – taking naps on the couch – so that he doesn’t have to climb the stairs until he goes to bed for the night

good luck
eve

[Neil]

Hi Maureen,
His fatigue is from the low RBC/HGB. There isn’t enough oxygen getting to his organs and his heart has to work a bit harder to circulat what oxygen there is in his blood.
Vidaza typically drives counts down after starting on it. If he is going to respond the counts will begin increasing after a while. Believe the docs will stop the Vidaza if his counts get too low.
If he gives himself the Procrit shot Medicare will not pay for them. Als assume he gets a CBC before each shot. This keeps his counts in front of the techs, nurses and docs. A good way to keep them on top of his status.
Are they doing anything to address his blasts?

[patti]

Neil,

Medicare prescription drug program does cover mom’s neupogen. Why wouldn’t they cover the procrit as well? My understanding from when we looked into procrit at home for mom also was that they would cover it. Mom’s initial cost for the neupogen was high (around $3000) but after that the shots run around $145 month for 8 of them.

Patti

[Neil]

Hi Patti,
Medicare covers Procrit and Neupogen under
Part B and supplemental insurance (if the patient has one) only if the shot is administered in a docs office. If a patient chooses to administer the shot at home Medicare will not pay benefits.
The patient can give themselves a shot at home
if they elect to use Medicare Part D to pay the cost. They pay a monthly premium (in addition to the cost of Part B)and then pick up the cost of the donuthole (unless they opt for the higher monthly premium some insurance carriers offer). There is no assurance the insurance companies will continue to include Neupogen and Procrit in their formularies. They could be dropped at a future date.
Getting Procrit and/or Neupogen at the docs office is the lowest cost option—- unless the patient has a retirement plan with creditable coverage where the former employer picks up the cost of all insurance including drugs or they are covered under the VA (Tricare For Life).
If there is a retirement plan DO NOT LOSE THE LETTER OF CREDITABLE COVERAGE.

[maueenh]

He is scheduled to see the doctor tomorrow. I thought that they were giving him the neupogen in place of a tx or to possibly defer the need for transfussion. Neil- Isn’t the Vidaza for the blasts? If not what do they usually administer for blasts? I live about an hour away from my parents so I am heading over this morning and will check his condition. I doubt I can convince him to go over to the hospital today but we’ll see.
Thanks for the support
Maureen

[Neil]

Hi Maureen,
Neupogen would not replace a packed red cell TX. It is intended to increase WBC counts. They would TX WBC only if there were a raging infection and WBC was at or near 0.0. WBC TX last a couple hours. The doc probably put him on Neupogen as a precaution against infection if his neutrophil count is getting around 500
Vidaza may or may not impact blasts. About 18% of patients respond to it. Docs usually use a couple chemo drugs to lower blasts.
Hopefully Suzanne will come on and have some input. She has a great grasp of RAEB treatments.
Remember Vidaza will drive counts down after starting. If he is going to respond they will begin increasing– at some point. The docs will depelop a plan to determine if they should reduce the dosage. interrupt the drug for a while or discontinue it. Procrit is often used with Vidaza to support red cell production.

[patti]

Neil,

Mom is using the part D plan for her home shots. You are correct about part B not paying unless they are at a doctor’s office. With the changes mom’s health plan made to her medicare plan it ended up being $5 cheaper for her to give them to herself at home! Can you believe that? In the beginning though, the doctors office was the only way we could get them. For us, driving 2hrs twice a week was so prohibitive. I feel like I have most of my life back only having to be gone twice a month for 8hrs both days. What a relief.

Patti

[Neil]

Hi Patti,
I hope your MIL has the Part D option that provides maximum coverage. It is more expensive (monthly) but may be far less expensive annually.
Has she received her “Explanation of Benefits”from her Part D Provider? It provides a monthly summary of benefits for the previous month and a cumulative statement for YTD benefits. This will give an indication of how long her benefits will be paid if she does not have the maximum benefit program.
There are many people who do not understand that most policies quit paying when the insured out of pocket expense and the amount the insurance co. pays total $2250 and resume when the total reaches $5100. The difference between $2251 and $5100 ( the donut hole)is the insured responsibility. Some are just beginning to find they are paying the full amount for their drugs now.

[patti]

Hi Neil,

Mom did not have any options regarding what type of plan D coverage to get. Her plan offered a flat out single option and everyone was put on it unless they specifically requested not to be. Mom met her “donut hole” with the first 8 shots. The neupogen shots are very expensive and by the time she ordered her second round of shots she had already hit the “they pay 95%” clause. She has not received any EOB from Providence regarding her drugs. They’ve just been covering. She shows me everything she gets medical wise and she hasn’t shown me that so far. I’ll have to ask her about it. Ya know, I was a licensed insurance agent for four lines of insurance (including health) for 5yrs and this stupid drug program is hard for me to understand! Good grief. I know insurance pretty darn well too. I feel bad for people (like my MIL) who don’t understand it at all.

Patti

[Neil]

Hi Patti,
Go to http://www.medicare.gov
Put your MILs dosage and frequency into the appropriate locations under the plan selections and the site will provide all of the options available in her state.
She is not required to deal with a specific insurance carrier. She can select from all of those available. She can use Ptovidence as her supplemental and have BCBS or Medica or Aetna for Part D. She can change her Part D carrier in Nov abd Dec of 2006 if she wishes.
In Minnesota we had 42 different options to select from earlier this year. Believe it is higher now.

[Suzanne]

patti, The only way I know that your Mom in law would have been put on something automatically is if she is on medicaid. They did put those on a plan but I believe those people still had the option to change programs. If she is just on medicare she would not have been put on a plan D unless she chose one. When I looked at the plans I put all the drugs that I had ever had-in or out of the hospital on the “formulary list” on the medicare site in order to choose a company. A dr. can also appeal for you to get a drug covered. And many of the drugs we might take can be put under Chemotherapy in the B part of medicare. You are abolutely right tho-It is a real nightmare trying to figure out how to get the best coverage!

[maueenh]

They gave my father both Procrit and Neupogen today and will do the same tomorrow and then test his blood counts on Wednesday. They mentioned doing the Procrit for 5 days and the Neupogen for 10 days and hopefully he could avoid a tx. Has anyone followed this protocol? I thought a tx would be better but maybe not.

[eve]

just curious as to what dose they are giving him with each procrit injection – this was never suggested to my dad – when his hgb got low (and for him low is in the low 9’s) he got a tx

let us know if this works – would be very interesting

good luck
eve

[Author]

Posts