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Infusion Center vs Doctor’s Office for Specialty Meds

The doorbell rang a few minutes ago and it was the mailman.  He had a certified letter for me from my pulmo's office.  Wasn't sure what in the world they would be sending to me in a certified letter!  The letter says the office is no longer administering specialty medications.  After Dec 1st  ( yep tomorrow!  )  they are providing Infusion Express with all the referral information to accommodate my specialty medication needs.  The letter does say that the pulmo's office WILL administer ALL remaining specialty medications if I have any remaining with them.   I have my Xolair shot in about two weeks so I don't imagine they have it yet.  I will call them Monday to find out.  It looks like Infusion Express administers IV therapies and injectable drugs like the Xolair I get.  Has anyone had any experience with this type of establishment?  

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  • Deborah Bartlett

    No. I have not. But this could end up happening to all of us with state insurance regulations, etc. I have had to go through a bunch of red tape for many different things in the past 6 months. It's getting annoying. You didn't get any notice whatsoever. Hopefully this all works out in your favor. 

  • Kathy P

    Hi Lisa – I get infusions and mine go through a specialty pharmacy / infusion center. The specialty pharmacy handles the supplies. The associated infusion center provides the facility and nurses.

    Mine isn't Xolair or other biologic though and I now administer at home. I had my first infusion at their center, then transitioned to visiting nurse and then to self-administration. At the infusion center, that's all they do is infusions.

    It may be that your doc's office has determined that it's not cost effective to have their staff dealing w/ the Xolair and other specialty situations – that's just my guess. I know at my allergist, there is "Xolair Day." They have specific days for certain specialty procedures (like Xolair shots, food allergy in-office challenges, OIT doses , etc). This helps their scheduling and resource (rooms, shot nurses) allocation.

    I hope you can talk to someone on Monday to make sure everything is in order by time you need your next shot. Hang in there!

  • Melissa G

    Lisa, I hope when you call the dr's office on Monday you get some clarification about what is going on. 

    I do all of Bekah's "stuff". Even when Bekah started getting IV fluids at home, a nurse came out to the house to do it. After the PICC line was placed, then I took over all of the care. 

  • LK
    Kathy P posted:

     

    It may be that your doc's office has determined that it's not cost effective to have their staff dealing w/ the Xolair and other specialty situations – that's just my guess. I know at my allergist, there is "Xolair Day." They have specific days for certain specialty procedures (like Xolair shots, food allergy in-office challenges, OIT doses , etc). This helps their scheduling and resource (rooms, shot nurses) allocation.

    Thanks Kathy, I was thinking the same thing that it just isn't cost effective for them.

    Thank you everyone for your comments and thoughts!!  

    One thing I did like about it being at my pulmo's office was that if I had questions for him while I was there one of the nurses could quickly ask him for me.  I realize that doing that takes up their time but sometimes I don't think of those questions until I am there.  

    I will call the infusion center on Monday and ask about my insurance and whatever else needs to get done.  When I started my Xolair shots it took weeks to get set up so I am hoping since I am already on them it won't be such a drawn out process just because it is at a new facility.

  • Kathy P

    Hopefully there aren't any insurance glitches. And that the infusion center gas open appointments!

    I'm in insurance **** again over my stuff because we are changing the dose. Ugh! 

  • LK

    Hadn't thought about if they would have appointments available when I am due for my injection.  Thank you for mentioning that Kathy.  I'll make sure and call Monday.

    Hope your insurance gets straightened out quickly!

  • Melissa G

    Uughh, on insurance woes. 

    Kathy, do you have an insurance care coordinator? Ours has been amazing helping me navigate things when we get delayed or denied things. 

  • LK

    Melissa,  Is an insurance care coordinator affiliated with the insurance company?  

  • Melissa G

    Lisa, they are. They help you navigate through stuff. I had no idea you could ask for one until Bekah's lyrica was denied earlier this year. Our pediatrician told us about the program. It's amazing. 

  • Kathy P

    I don't have an insurance coordinator. But there is one point person at my allergist's office who deals with all of the IG stuff. She's one of the shot nurses. So she's my go-to expert for navigating the related insurance stuff. In fact I checked in with her on Wednesday when I was in for my shot. 

  • LK

    Update – Talked with my pulmo's nurse.  She checked and they have one more dose of my Xolair so I will get that at their office on the 12th and then talk with him the next week at my appointment with him as to whether I am continuing on the  Xolair or what the next steps are.  

  • LK

    Thanks, Deborah, yes, it does give me a little breathing room!  (Couldn't resist the pun!       

  • K8sMom2002

    what Deborah said — punny!

    Lisa, so very glad you do have that breathing room. You may need a pre-authorization from the infusion center since it will be a "new provider." But hopefully it won't be as hard to get as the first one was.

    Do you think the Xolair has continued to help you? 

  • LK

    I truly can't really tell much of a difference since being on the Xolair.  I talked with my pulmo about it at my last visit and he and I were both hoping I would see more of an improvement with it.  Thank you for asking!

  • Kathy P

    Ugh, that's unfortunate that you are not seeing a big difference. Good luck with the appointment on the 12th! I hope you can get a handle on the plan going forward.

  • LK

    Thank you, Kathy!  How is it going with the insurance since your dosage has changed?

  • Melissa G

    Lisa, that stinks that you have not seen a change since taking the Xolair! I hope the pulmo has a great plan moving forward. 

  • K8sMom2002

    That stinks that you didn't get a big bump of improvement with the Xolair … but did it help you stabilize things? Were things trending in the wrong direction before, and now trending in the right direction? 

    I hope your doc and you can have a good discussion about whether you SHOULD have seen the positive effects of Xolair by now … and whether there is something else that might work better?

  • LK

    Cynthia,  I don't think it even really helped stabilize things either, unfortunately.  No real noticeable difference that I could see.  My pulmo has mentioned that new asthma biologic, Dupixent, that I also read the AAFA news release about.  Will definitely talk in depth with him about what we can do next.  I've been on the Xolair since the first part of April and was holding steady before that.

  • K8sMom2002

    Well, I guess it was worth a try! I am SO hoping that your pulmo and you can work together to get something that WILL help. 

  • LK

    Have my Xolair appointment at the infusion center tomorrow so will let you all know how it goes!  

  • LK

    Deborah,  You have the best outlook on each day!!  Thank you!  

  • LK

    The infusion center was very nice!  Very professional staff and a comfortable atmosphere.  

  • Deborah Bartlett
    LK posted:

    The infusion center was very nice!  Very professional staff and a comfortable atmosphere.  

    So refreshing. It's so nice to hear something good!

  • LK

    True!  Anymore I am kind of leery when going to a new place.  Just don't know what to expect but definitely a nice place.