Need Bridging Therapy For Pulmonary Embolism But No Insurance?

I'm not sure what your experience is with Arixtra or Lovenox for bridging therapy for pulmonary embolism, but there are some quirks in the insurance market that provides for options  if you have health insurance but not medication insurance to cover injectable drugs.   Most insurance companies separate medication coverage out from in-patient hospital coverage,  physician fees, outpatient radiology and laboratory services.  If you want medication coverage, some insurance plans, including Medicare and their Medicare Part D,  may require you to purchase an additional policy.  

I ran into an example where a patient with a pulmonary embolism was fully insured from a hospital and physician standpoint.  Unfortunately, his private insurance did not cover medications.  When it came time to discharge the patient, I discovered he would not be able to afford bridging therapy with Arixtra or Lovenox for his pulmonary embolism.  He  was not yet therapeutic on his Coumadin which meant he required additional injectable anticoagulants before he could be safely be discontinued from his injectable therapy.  

Originally, I thought the only  safe options to treat this patient would be to send him home with free samples of Lovenox or Arixtra as bridging therapy to his warfarin pills or keep him in the hospital as long as it took for that to happen and get his injections in the hospital if no free medication could be secured.   That's how we used to do things in the uninsured  before the assistance programs came about a few years ago.  

Unfortunately, the Lovenox drug assistance program ended in 2011.  That means folks without insurance and who qualify for medication assistance based on finances should try the Arixtra program instead for their bridging therapy.   Arixtra has not yet abandoned their assistance program.   Most hospitals these days will not provide free medications for discharge, especially with negative hospital  profit margins from Medicare and the catastrophic ObamaCare policies right around the corner.  Unless you can make a compelling argument to the folks holding these medications in the hospital vault that it will cost more for the patient to stay in the hospital than to give them their medication so they can give themselves shots at home, these patients will stay in the hospital for many extra days if free medication cannot be secured.

But what about the folks who have insurance but not insurance for medication.  What if they don't qualify for free medication assistance?  One really strange quirk in the land of third party insurance is that some insurance companies will pay to have you drive once or twice a day to an outpatient specialty clinic that is run by nurses who provide nursing care all day long at hospitals all across this country. 

These nurses  may do wound care, lab draws, drug administration and a whole assortment of other tasks on a daily basis.  Oddly enough, many insurance companies will pay for you to get in your car, drive 20 miles to the hospital, check in, wait in line, get your lab drawn, and get your Lovenox or Arixtra injected by a nurse.  They'll pay for your medication and the nurse injection if you are willing to take off work, call in sick, use your PTO hours, waste your gas money and disrupt your life to get your necessary medication at the expensive hospital specialty clinic instead of doing this easily teachable task in the comforts of your home or office because you don't have medication insurance.  

To make matters even more complicated, some insurance companies may only pay for Arixtra and not Lovenox or the other way around.  What a complicated network of rules and regulations doctors and patients must navigate.  This is where great social workers are indispensable.  Now, raise your hand if you think ObamaCare is going to make things cheaper for us all!  Since things are always changing, make sure to checkout  to see if you qualify for hundreds of medications therapies. 

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