I was supposed to be taking Lynparza by now. I should be a couple weeks into trying the new PARP inhibitor that was going to become my maintenance drug for as long as it would work. It was supposed to help the histotripsy procedure keep me without evidence of cancer for as long as possible.

That was my destination. The journey was supposed to start with Lynparza, cruise along to histotripsy, and drive on home to a lengthy reprieve from this medical adventure. But I seem to have hit a few speed bumps, and right now I'm traveling on a street paved with insurance claims, financial assistance applications, appeals, denials, and pre-authorizations. And I'm stuck here in a traffic jam. 

I currently don't pay for any of my other medications. Thanks to chemotherapy, I hit the out-of-pocket maximum on my insurance early on for the third year in a row now - so even the pricey $2,160 per month Creon (the pancreatic enzyme taken with each meal and snack), costs me nothing. Even all of my chemotherapy has been paid in full after I reached my deductible. But it seems all of that is coming to a skidding, screeching halt now.

Damn this traffic jam.

My first hint of the coming bottleneck was my insurance company denying my prescription for Olaparib (aka Lynparza). I wasn't really too thrown off course by that. I knew that Lynparza was approved only for people with a BRCA mutation. And I have an ATM mutation. Same DNA repair thingy - different gene. It might still work well for me, but it hasn't been really tested or proven, and the FDA hasn't approved it for me yet (and likely won't in my lifetime). Therefore my insurance doesn't want to pay for it. The appeal didn't appeal to them either. Without BRCA, my insurance will be of no help. 

I wasn't daunted by this pothole in the road. I knew that AstraZeneca, Lynparza's manufacturer, has a program called AZ&Me. It's designed to help those who can't afford medication gain access to it. Missy, my specialty pharmacist (I have one of those now 😆) sent me the application, and collected a bunch of my financial information. So she and AstraZeneca now know how much (or little) I make.

Librarians aren't known for their high salaries. So I was surprised when Missy called to tell that my application for financial assistance was denied because I didn't meet their income requirements. She said, "I'm really sorry. I didn't know their cut-off was so low." 😆 (I guess I should've been a pharmacist💲😁)

I called the AZ&Me program after I hung up with Missy. The poor woman on the phone had a tough time answering my questions. She asked if it would be alright to put me "on hold for 3 to 5 minutes" at least 3 to 5 times. Each time I asked her how much Lynparza costs monthly she tried to deflect by offering me a website with foundations that might give me grants for my medical bills. (A word to the wise: Never try to distract a librarian with lists of funding resources. She knows them better than you). Finally I asked her where I could find out how much Lynparza would cost me out-of-pocket. She put me on hold for 3-5 minutes while she went to find out. She came back in less than 3 to 5 minutes with the wholesale price - $15,980 per month. I tried to ask her how it might be possible that I could manage to pay that on my salary. Instead of speculating, she went over their guidelines again. And we hung up.

Damn this traffic jam. 
How I hate to be late.

It's been 6 weeks now since my last infusion. And no treatment in sight yet. The worst thing about cancer is the waiting. And I'm feeling behind the game here. 

It's hurting my motor to go so slow. 

I have to shift gears. Find another way through the traffic jam.

I did what librarians do best. Research. I searched the clinical trials database for studies involving olaparib and pancreatic cancer that are currently recruiting. I am not a good candidate for most of them, but there is one, and one is all I need. Okay - so it's at Sloan Kettering in New York City, but I think I can get there.

If I get into a trial with olaparib, the drug will be free as long as the trial is going on (what happens after that I don't know, but we'll cross that bridge if we ever get to it). So I emailed the lead researcher, and also Dr. Bajor, to inquire if I might be a candidate. I don't know what will come of it, but doing something seemed better than being stuck in that traffic jam.

I also have an appointment next week to consult with a Cleveland Clinic liver specialist about the histotripsy procedure. I've been excited about that. I want to say goodbye to this adventure buddy that's been riding along with me on this road trip. But then Dr. Bajor suggested that histotripsy might make me ineligible for the clinical trial. 😳 Another potential roadblock. 

And now I'm more than a little apprehensive that my insurance will also deny coverage for the histotripsy too. They've been good about covering everything until recently. Now that I am going beyond the standard of care, and wanting to try something new, they are not so eager to comply with my treatment plans.

Friday there was a voicemail on my cellphone at the end of the day from a Cleveland Clinic financial advocate asking me to call her back at my earliest convenience regarding my upcoming appointment. 

That can't be a good sign. 

It was 3:52 pm on Friday when she left that voicemail - likely her last call before going home for the weekend. 

She wasn't there when I called back.

So here I am again...waiting.

Just in time to stand in line with the freeway looking like a parking lot.

Damn...

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Damn, this traffic jam
How I hate to be late
Hurts my motor to go so slow
Time I get home my supper'll be cold
Damn, this traffic jam

Now when I die
I don't want no coffin
Thought 'bout it all too often
Just strap me in behind the wheel
And bury me with my automobile
    ~James Taylor

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Attached to this entry is the studio recording of Traffic Jam from the 1977 JT album. This is the one I used to listen to on road trips during my college days. But I also found this terrifically fun live version from a German TV program produced in 1986 (this clip has a bonus performance of Sea Cruise too). Another great version from his concert film, Squibnocket, was filmed in 1992. And he was still singing the song more recently.

This is a song that will never get old as long as we drive cars! 😂🚘