I was recently hired by a family whose loved one was taking an experimental drug for cancer. The cost of the drug was more than $8,000 a month. Because the drug is experimental, it is not covered by private insurance, Medicare, or Medicaid. The drug was being paid for by a grant that required re-application every year.
The senior was at risk for falling, had a catheter, and had been admitted to a rehabilitation community covered by Medicare. However, one of the children informed me that finding a community that would accept the loved one (due to the experimental status of the drug) was a challenge. Their first choice in rehabilitation communities declined to offer the senior a bed since the drug wasn’t covered by Medicare. The administration at the community did not want to incur any liability for absorbing the cost of the drug. The second choice in rehab. communities admitted the senior, but required the children to purchase the drug and bring it to the home for administration to the senior.
When the senior’s Medicare days were exhausted, it was time for me to find a permanent home for him. While a family member told me that it was probable that the grant would be re-issued to cover the drug for another year, I had to bear in mind that at some point the grant may stop paying for the prescription. Thankfully, this senior had enough money to pay for long term care, and the prescription for several years, before applying for Medicaid. However, all the communities that I approached for his placement required that the children would still have to pay for and deliver the prescription. Since the senior had progressed during rehabilitation, I was able to secure placement in a Continuing Care Retirement Community (CCRC) that offered high level, assisted living that was lower in cost than a nursing home, but could address issues with the catheter via their medical in-home care services. The senior eventually would be able to apply for Medicaid and transfer to the CCRC nursing home on the same property. However, should the senior convert to Medicaid status, the experimental drug will not be covered.
That is a challenge for another day. In the meantime, I would encourage this family and any family in a similar situation to speak with their senior’s physician about a potential alternative prescription. Years of work by ADSLA have shown me that solutions–or satisfactory trade offs–can always be found. It just takes knowledge, experience, and good ol’ fashioned perseverance!
For all of your senior living needs, contact Andrea Donovan Senior Living Advisors. Call us at (708) 415-2934 or email us. Please visit our website. Please watch my video to learn how the process works and learn what some clients have to say.