Health Economics 101

Health Economics 101: Avastin is part of a new class of drugs called mono-clonal antibodies. They are protein based drugs that can have decent efficacy with minimal side effects. I know quite a bit about these types of drugs because the company for which I work, Amgen, also sells similar drugs, or what we call "biologics". These are expensive drugs. One treatment of Avastin is $13,000 to $15,000-- ONE TREATMENT. Knowing this, I made sure my insurance would cover the cost of treatment, and I was assured that the drug did not require pre-approval (more about this later). So I started treatment.

Compared to chemo, there were absolutely no side effects from Avastin. I took it in the morning and was back at work in the afternoon and eating pizza by night. No problems period. However, about three days before my third scheduled treatment, I received a $28,000 bill from UCLA. OUCH!!!! It turns out "doesn't require pre-approval" does not mean that they will necessarily pay for something. I had to make the decision to continue with a treatment that would cost me $14,000 every three weeks for an unknown period of time (if the drug was successful, I could be on it indefinitely), or stop treatment. I made the call to stop treatment, no easy thing to do when you know you have tumors growing in your body and this treatment is your best chance at slowing their growth.

My doctor was great with helping me through the situation, but I essentially went without treatment from October 2008 until May 2009, since there wasn't any treatment that the insurance company would reimburse. Given that what I have is very rare, there really isn't a standard of care and my insurance company calls everything the doctor recommends "experimental" and thus they won't pay for it. I decided (or rather was forced) to take a few months of a break to sort out my options and focus on work.