Facilitating care that meets current standards

“Robin’s” ITA nurse saw a problem the moment she opened the files.  The metastatic breast cancer patient was receiving the new oral chemotherapy, Tykerb, but not its FDA-approved counterpart, Xeloda.  A call to her doctor revealed a limited prescription policy made Xeloda too expensive for Robin. Her insurer did cover weekly chemotherapy infusions, although they’re unproven with Tykerb. ITA called the insurer.  The infusions weren’t standard of care, and four months of them had cost $54,400.  The best care — Xeloda — would have cost $16,800.  ITA and a health plan case manager soon found a solution: an antiquated hospital billing system had hidden the fact that Robin had met her deductible.  Claims were updated, and Robin was switched to Xeloda without a co-pay. Total cost savings to date exceed $117,000.