Avastin in UK's NHS vs. USA Healthcare

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Re: Avastin in UK's NHS vs. USA Healthcare

Postby MissMolly » Sun Jun 10, 2018 10:34 am

The provisions of the Affordable Care Act have never been before the Supreme Court for legal review or decision.

The current administration is on a trajectory to undermine the Affordable Care Act. The withdrawl of the ACA’s individual mandate was a first act toward dismamtaling of the ACA.

The Affordable Care Act is more than the expansion of MediCaide and the availability of medical insurance to those not provide with employer-based coverage. The Affordable Care Act outlines basic legal requirements that medical insurance plans must provide. This includes routine and preventive care (colonoscopies, as would be of keen interest to this forum), maternity and delivery care, coverage for pre-existing conditions, and elimination of a life-time financial cap. The legal provisions of the ACA provide essential protections for employer-provided medical insurance plans - as well as the individual marketplace available plans. No one is unaffected by the Affordable Care Act.

Despite what you may think, several states have filed legal challenges in federal court this week challenging the constitutionality of the ACA’s provision for protection of pre-existing conditions. The first federal filing will be decided by a federal judge in Texas who was appointed during the Bush administration and has a background of strong conservative orientation to her decisions and rulings. The point being: Protection for pre-existing conditions is under siege. This is not “fake news.”

Anyone with any relevant health history should be rightly concerned and should be tracking developments through reputable news sources carefully in the days ahead.
Dear friend to Bella Piazza, former Colon Club member (NWGirl).
I have a permanent ileostomy and offer advice on living with an ostomy - in loving remembrance of Bella
I am on Palliative Care for broad endocrine failure + Addison's disease + osteonecrosis of both hips/jaw + immunosuppression. I live a simple life due to frail health.

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Re: Avastin in UK's NHS vs. USA Healthcare

Postby NHMike » Sun Jun 10, 2018 11:30 am

WarriorSpouse wrote:MissMolly, Thanks for sharing your story and the specifics with the ACA. No doubt the ACA has been helpful for those in similar positions. I would not expect those policies to change, since they are mostly covering those who need it most. The premiums and deductible appear to already be priced in for pre-existing conditions. I am not certain if what you are reading, if passed, may actually put more people on the ACA plans, and in a weird way, could lower premiums there by increasing the pool of ACA consumers. Time will tell, but clearly Congress did not have the appetite to fully eliminate the ACA, and for good reason.

NH Mike, Thanks for sharing the Dana Farber / Norwegian article. This is another example of the national plan doing cost benefit analysis and dictating what they will pay for and not. Fortunately, for the patient she has a legitimate reason to be seeking treatment at Dana Farber in Boston.

BoxHill, I am sorry to hear of the position you describe. I have provided some ideas based on my limited knowledge. I would suggest using the hospital's oncology nurse navigator to help you find additional things that we are not discussing here, that may also help if needed in your area. Good luck in your process moving forward.

Does anyone else have a story to share where a cancer drug is being denied simply due to the cost that will not be covered by Insurance or the State run program, similar to the UK and Norwegian articles linked above?


Not specifically a cancer drug but there is this WSJ story:

The couple flew to San Francisco and paid $70,000 out of pocket at UCSF Medical Center, where doctors recommended that Mr. Lin try radiation therapy rather than surgery. Now, his family says his tumor is gone and he can still walk.

Mr. Lin thus joined an emerging group of Chinese going overseas in search of treatment that is either unavailable or ineffective in China. It is next to impossible to pin down the number of such "medical tourists."

https://www.wsj.com/articles/desperate- ... 1409959941

WSJ is typically paywalled though they might provide access to older articles.
6/17: ER rectal bleeding; Colonoscopy
7/17: 3B rectal. T3N1bM0. 5.2 4.5 4.3 cm. Lymphs: 6 x 4 mm, 8 x 6, 5 x 5
7/17-9/17: Xeloda radiation
7/5: CEA 2.7; 8/16: 1.9; 9/8: 1.8; 11/30: 0.6; 12/20 1.4; 1/10 1.8; 1/31 2.2; 2/28 2.6; 4/10 2.8; 5/1 2.8; 5/29 3.2; 7/13 4.5; 8/9 2.8
10/17: 2.7 2.2 1.6 cm (-90%). Lymphs: 3 x 3 mm (-62.5%), 4 x 3 (-75%), 5 x 3 (-40%). 5.1 CM from AV
10/17: LAR, Temp Ileostomy, Path Complete Response
CapeOx (8) 12/17-6/18
7/18: Reversal, Port Removal

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Re: Avastin in UK's NHS vs. USA Healthcare

Postby NHMike » Sun Jun 10, 2018 11:37 am

MissMolly wrote:Warriorspouse:
Please refer to a reputable news source to become informed of the current legal challenges being filed in federal court regarding pre-existing conditions.

The filings are contesting the constitutionally of medical insurance providers to be required to cover for pre-existing conditions, as is now mandated by the Affordable Care Act. It is a calculated attempt to have the mandates of the ACA declared unconstitutional and the provisions of the current law deemed unlawful. The federal filings, if successful, would erase coverage for pre-existing conditions and would be a seismic affront to the hard-won protections now enshrined in the law. I suspect this matter will wind its way through the federal court system to the Supreme Court.

I would include a link to a mainstream news source but I am technically naive as to how to post a link on a personal forum post such as this.

Protection for pre-existing conditions should be of vital interest to anyone and everyone. Any inkling of an infirmity on your medical record can be considered a pre-existing condition by the purveyor of an insurance adjuster. Example: A discussion of irritable bowel with your MD can be used against you in later years if there arise gastrointestinal symptoms to deny coverage. Asthma, depression, diabetes, attention deficit disorder, seizures, seasonal allergies, hypothyroidism, - the list is endless of pre-existing conditions that follow a person on their medical record. The passage of the ACA and its legal protection for pre-existing conditions is something that protects people from the very real threat of medical bankruptcy.

The Affordable Care Act affects not only individuals who purchase medical insurance on the open market but also employer based plans by specifying the legal obligations of medical insurance providers in the scope of services that must be covered. The recent federal filings challenging the pre-existing condition coverage mandate of the ACA should have everyone concerned.

Anyone can have my misfortune of falling ill and being unable to sustain employment that provides for employer-provided medical insurance benefits. Anyone.

And the truth is that everyone will be “sick” and require access to healthcare in their lifetime. Anyone who feels that they are healthy and can forego medical insurance is myoptic.

The pricing structure of healthcare in this country is in the stratosphere and beyond the ability of even the financially secrure to self-pay. And healthcare pricing does not take into account the benefit, or lack of, for the healthcare expenses incurred. For all of the healthcare services that I access, my quality of life is marginal and my state of health poor. I am barely treading water.

We are in troubled times as a nation and as a world.

Consumers and insurers face new uncertainty with the Justice Department’s assertion this week that key provisions of the Affordable Care Act are invalid.

In a brief filed Thursday, the department asked a federal court to unwind the health law’s protections for individuals with existing medical conditions, such as diabetes or asthma. The law, known as Obamacare, prohibits insurers from refusing to sell coverage to people with pre-existing conditions or from charging them more than healthy consumers.

The brief was filed in a lawsuit brought by attorneys general that may take months to wind through the courts, and it isn’t clear what the outcome will be. Changes would create winners as well as losers. Meantime, insurers face new variables as they are deciding where to sell coverage and at what rates in 2019.

Health insurers warned of disruption to the market. “Removing those provisions will result in renewed uncertainty in the individual market, create a patchwork of requirements in the states, cause rates to go even higher for older Americans and sicker patients, and make it challenging to introduce products and rates for 2019,” America’s Health Insurance Plans, a trade group, said in a statement.

https://www.wsj.com/articles/what-healt ... ding_now_3

WSJ is paywalled. I think that it's worthwhile paying for the news so that the organizations can afford to pay their employees to do a good job. WSJ is $15/month. NYT is $8/month. There are others but these are the two that I read.
6/17: ER rectal bleeding; Colonoscopy
7/17: 3B rectal. T3N1bM0. 5.2 4.5 4.3 cm. Lymphs: 6 x 4 mm, 8 x 6, 5 x 5
7/17-9/17: Xeloda radiation
7/5: CEA 2.7; 8/16: 1.9; 9/8: 1.8; 11/30: 0.6; 12/20 1.4; 1/10 1.8; 1/31 2.2; 2/28 2.6; 4/10 2.8; 5/1 2.8; 5/29 3.2; 7/13 4.5; 8/9 2.8
10/17: 2.7 2.2 1.6 cm (-90%). Lymphs: 3 x 3 mm (-62.5%), 4 x 3 (-75%), 5 x 3 (-40%). 5.1 CM from AV
10/17: LAR, Temp Ileostomy, Path Complete Response
CapeOx (8) 12/17-6/18
7/18: Reversal, Port Removal

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Re: Avastin in UK's NHS vs. USA Healthcare

Postby WarriorSpouse » Sun Jun 10, 2018 1:46 pm

"National Federation of Independent Business v. Sebelius, 567 U.S. 519 (2012), was a landmark United States Supreme Court decision in which the Court upheld Congress' power to enact most provisions of the Patient Protection and Affordable Care Act (ACA), commonly called Obamacare..."

https://www.washingtonpost.com/politics ... b58fb76962

https://www.npr.org/2015/06/25/41743529 ... -subsidies

The Washington Post and NPR are credible sources.
Spouse of wife 47 years old
10/2014, Stage IV Metastatic CC
Lymph node involvement 12/15, w/ positive PET on para-aortic lymph nodes.
5 cm sigmoid tumor resection as well as positive Virchow lymph node.
KRAS mut, Highly Differentiated, Lynch Negative
Folfox and Avastin 1 YR (Oxi for 5 months) NED 05/2015
Zeloda and Avastin since 01/2016
Chemo break 03/2017, back on Zeloda and Avastin 04/2017.

"...Perseverance is not a long race; it is many short races one after the other."
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Re: Avastin in UK's NHS vs. USA Healthcare

Postby crikklekay » Sun Jun 10, 2018 10:45 pm

WarriorSpouse wrote:Again, has anyone have evidence of being denied a drug or treatment that is known to work for the patient due to costs, similar to the UK and Norwegian examples referenced above. Thank you.

I don’t have any links to news stories but I have two anecdotes. When my husband had CDIFF due to the antibiotics he was on for his steph infection he was prescribed vancomycin due to the length of time he needed to be on it they didn’t want to put him on Flagyl since it can build up and have neurological side effects. What I didn’t realize is that vancomycin is expensive and the insurance company would only allow a certain amount. He was only halfway through his treatment when CVS told us they couldn’t give it to us anymore because the insurance wouldn’t cover it. It took a week of our Oncologist going after the insurance company until they finally relented.

My other anecdote comes from my best friend who is a type one diabetic. She needs insulin to survive and yet recently her health insurance has refused to cover it because she isn’t taking a generic form. Thanks to our laws and how medical patents work there is no generic form of insulin. Her doctor had to fight with the insurance company to get it covered, and even with insurance insulin and diabetic supplies are expensive. She also has Crohn’s disease and her insurance refused to cover her Humira because it’s a high cost tier 3 drug even though it was the only thing that worked. She applied for aid from the pharmaceutical company that makes it and they gave her coupons which helped, but her insurance company refused to pay a dime.
Caring for DH John, 41
DX: Colon Cancer, Sigmoid colon
Tumor type: Adenocarcinoma
Tumor grade: G2, Moderately differentiated w/invasion of visceral peritoneum
Stage IIIC
Positive lymph nodes: 6/22
Chemotherapy: FOLFOX (6)
12/17 ER and emergency surgery
02/18 Hospital w/ MSSA infected port, PICC line inserted, abdominal CT scan clear chest CT scan showed septic emboli & blood clots
03/18 Hospital w/ CDIFF
04/18 Chest CT scan clear
06/18 Colonoscopy Clear
08/18 CT Scan Clear, NEMD

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