Showing posts with label dmds. Show all posts
Showing posts with label dmds. Show all posts

Wednesday, March 10, 2010

My MS backpack is here!

These are the contents of my MS backpack. I had it delivered to my workplace today. I am not even going to go into how Purolator screwed up the delivery of this backpack THREE TIMES, but I guess the fourth time is a charm.


Because I enjoy lists, I will list what is in my ugly, lame backpack.

1. Insulated lunch bag with cold pack insert - This is for taking my Copaxone outside.

2. Refrigerator lock box. Presumably the pre-filled glass syringes should be in a box that is locked. The keys are magnetic and they'll be stuck to the fridge door and say "COPAXONE" on them, so it's not going to take a rocket scientist to get my fits out of the fridge. I realize that this lock box is probably more for the safety of children who live in the home, but I'm far more likely to have a junkie break in looking for drug paraphernalia than a small child near my fridge. Not that a junkie break in is at all likely either.

3. Autoject2 - This is an auto-injector. It is patented and has registered trademarked name.

4. Needle clipper - I guess in case the needles that come on the pre-filled glass syringes are too long.

5. Travel box and travel card - Holds a week full of syringes. It has a card that states what Copaxone is, why it has been prescribed to me and what temperature it needs to be stored at.

6. Wing extender with instruction sheet - It makes the end of the syringe wider for your fingers to hook onto as you inject. The instruction sheet makes it seem very simple.

7. DVD - Self-Injection Training - I'm guessing that this the feel-good, runaway, smash hit of the spring. I have to watch it before the nurse comes over to teach me how to do it.

8. Injection pad - I hope this is covered in the DVD materials, because I can't for the life of me figure out what it's for.

9. Daily Planner - "Rotating injection areas and injection sites is important because it may prevent short-term and long-term skin reactions related to any kind of subcutaneous injection." Rotating your areas/sites is important to keep your skin "from becoming hard, sore or indented from repeated injections."

Awesomesauce.

10. Compress - Hot/Cold - To help combat normal subcutaneous injection site reactions, apply the cold compress for 5 minutes before the injection and for 5 minutes after.

YAY!

11. Injection support mat - It gives you directions for everything you need to do your injection, either manually or by auto-injector.

12. Patient's Guide to Understanding MS - (Comes with a map of possible injection sites) - This book looks like the world's skinniest recipe book except instead of Appetizers, Entrees and Desserts it's got tabs for Multiple Sclerosis, Copaxone and Support.

13. Brochure - "All Shared Solutions nurses are professionals who specialize in MS; most have been certified by the International Organization of MS Nurses (IOMSN), a group committed to excellence in MS patient care. (Certification requires at least 2 years of experience with MS patient care.) My nurse's name is France and she's in Montreal. I practice my French with her. She is kind enough to tolerate my anglophonie ass.

BUT WAIT THERE'S MORE!!!!!!!!!!!

14. A copy of the Shared Solutions privacy policy, in both French and English.

15. One of those neck cooler things that you soak in water and wear around your neck to keep the blood going to your brain cooler.

16. My nurse's business card.

17. A copy of the latest issue of MSDialogue - Science, medicine and support for those whose lives are affected by MS. It comes with an invite to get a free subscription.

and finally...

18. A pen.

NOW, if our private insurance would just hurry up and approve my drug exception form and cover the $1,750 deductible on my Fair Pharmacare, I can actually get the nurse over here and start this stupid drug.

If private insurance is so much better than single payer, why did it take 48 hours for me to get approval for Copaxone by the government program, but three weeks after receiving the forms my private insurer is still thinking about paying $1,750. For the whole year. It's not even like that's a monthly fee.

Efficiency my ass, I say.

Thursday, January 21, 2010

Flow Chart to MS DMDs

I don't think I can fully explain how much I love flow charts. Pie charts and bar grafts too. Unfortunately I don't want to do tables and all that so I will just number this one.

Special Therapies Pre-Treatment and Special Therapies Treatment Phase

Pre-treatment Phase


Step 1 - Referral to Special Therapies Program

I was referred to the STP by my neurologist who screened me for inclusion in the program based on the BC Pharmacare's prescribing criteria

Step 2 - Patient Education (3 hour group session)

This is what I attended today where I got this awesome flow chart

Topics covered

- review of what MS is
- description of available drugs & how they are administered
- clinical trial study results
- side effects profile and management
- patient expectations
- Pharmacare coverage

According to the facilitator, this patient education program was mandated by BC Pharmacare to help lessen "prescriber bias". The four drugs were approved by Pharmacare around the same time and knowing that one or two of the drug companies had funded hundreds of thousands of dollars of research in the province they wanted to make sure that patients were getting access to the drug they wanted to take, not the one their neurologist wanted them to to fund his/her research. Every person who is going to start an MS medication in the province of BC has to take this education session.

Step 3 - Patient to call Special Therapies Program secretary with drug choice.

I don't have to do this one because my drug choice is already made. My doctor has already filled out the forms, I just had to go to this session because it's the rules.

Step 4 - Pharmacare approval (takes approx. 1 week)

As far as I know, I already have my approval.

Step 5 - Package to be sent to patient
- bloodwork requisitions (if you are on beta-interferons)
- Pharmacare approval note (for secondary insurers, if they require it.)
- neurologist letter (for additional insurance back up or for travel)
- travel tips

Step 6 - Bloodwork screening (not required for Copaxone)
- bloodwork must be done before prescription given to patient

Step 7 - Prescription given to patient

Step 8 - MS Clinic will send requisition to company support program for home start by RN


Treatment Phase

Day 1 - Injection training and drug initiation - home RN start

- first injection done with home nurse teaching

48 hours & 1 week - Follow-up phone calls

- You will receive a phone call from the Support Company Nurse regarding side effect management and support

Month 1 & Month 3 (approx) - Follow-up clinic visit - (optional)

- injection site reactions
- side effect management
- monitor bloodwork results (Avonex, Betasteron and Rebif - monthly for 6 months)

Month 6 - Optional clinic visit

- Monitor bloodwork results (not required for Copaxone)

Month 11 - Monitor bloodwork results (have blood test 1 month prior to appointment) [not required for Copaxone]

1 year - Annual review - make appointment with neurologist

- prescription renewal
- check injection sites and Special Therapies treatment issues

Pharmacare approval needs to be renewed each year with the prescription, and that's important because most private insurers won't cover the full cost of the medication without Pharmacare kicking in 70% of the cost, which is $1600 a month. Approval is never denied unless you no longer meet the residency requirement. The 30% will be covered by most private insurers up to your drug coverage percentage. (Ours is 80%.) This is going to cost me $96 a month out of pocket until my annual maximum has been reached. (The 80% of the 30% counts toward the annual maximum, btw.) I don't know what that is yet, because I haven't filed my 2009 taxes yet.

Thus ends the fabulous flow chart of MS drug therapy in the province of British Columbia.

*bows deeply*