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Aug 14, 2016 12:23AM
Aug 14, 2016 12:25AM
I had originally wanted Prolia rather than Zometa because: Prolia is a shot (can be given into any muscle) whereas Zometa must be infused I.V. (and I have only one non-lymphedema arm and darn few decent veins in it); Zometa makes you feel like you have the flu (muscle, bone & joint aches, fever, fatigue) for several days afterward, while Prolia doesn't; there's increasing literature to the effect that Prolia offers better protection against bone mets; and there are more instances of paradoxical horizontal thighbone fracture on Zometa/Reclast than on Prolia.
BUT I'm on Medicare, with both Part B and D supplements. My Part D is (in)Humana Enhanced, which is a misnomer if ever there were one (it won't even cover generic letrozole unless I “fail" three months on generic anastrozole first). Here's the rub: since Zometa is given via I.V. in the chemo or transfusion suite, it's a “treatment" which Part B, combined with that supplement (BCBS) covers 100%. But since Prolia is a shot, even if administered by a doctor at her office in a hospital cancer center, it's considered a “drug" (theoretically, I could inject it myself) and therefore subject to Part D. And my cheapskate Part D plan (supposedly the best in IL) won't cover one red cent of it........so my out-of-pocket cost would be $5,000 twice a year.
My MO says my osteopenia, combined with letrozole, will eventually become osteoporosis unless treated with either a bisphosphonate (oral like Fosamax or Boniva or I.V. like Zometa) or Prolia. But she also says I'm not at such high risk for progression to osteoporosis that I have to do it right now, nor am I at high risk for bone mets. She suggests that come Oct. open-enrollment, I check to see which Part D plans will cover Prolia and schedule it once my new plan takes effect Jan.1. However, both std. insurers and Part D carriers are cutting their formularies (which drugs they'll cover) and shifting once-cheaper drugs to higher tiers (requiring higher co-pays), and it's possible that what may be covered in Oct. might not be come Jan. 1.
I also read the fine print in the Prolia ad: “severe bone pain has been reported;" “serious infections and cancers have been reported." And that's the kicker--there might be more bone pain, longer lasting, than the fleeting flu-y feeling (repeat 3x quickly) from Zometa; and because Prolia (anything whose generic Latin name ends in “-mab" or “-nib") is a “biologic," to some degree it is an immunosuppressant...and I'm allergic to the three most commonly used groups of antibiotics--penicillins, sulfas, and floxins (e.g., Cipro). What good is stronger bones if I get lymphoma, multiple myeloma, MDS or succumb to a massive infection?
So I sucked it up, put on my big-girl panties and messaged my MO I'd like to go ahead with the Zometa. Waiting for her nurse to get back to me with available dates so I can pick one with nothing to do for three days afterwards besides lie around feeling like crap.
Diagnosed at 64 on routine annual mammo, no lump. OncotypeDX 16. I cried because I had no shoes...but then again, I won’t get blisters....
9/9/2015, IDC, Right, 1cm, Stage IA, Grade 2, 0/4 nodes, ER+/PR+, HER2-
9/23/2015 Lumpectomy; Lumpectomy (Right)
11/2/2015 3DCRT: Breast
12/31/2015 Femara (letrozole)