The Waiting Game

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I’m sure some of you may be wondering how my quest for Spinraza— the first treatment for Spinal Muscular Atrophy (SMA)— is faring. Obtaining this treatment isn’t for the faint of heart, it takes will, perseverance and just a little desperation— like climbing Mt. Everest, running a marathon, or taking a job in the Trump Administration.

As I’ve documented here, I’ve been examined by several Stanford doctors, I’ve had DNA tests, and I was approved and prescribed Spinraza… two and a half months ago.

But, I’m still waiting to receive the treatment. If I was a female chipmunk, I could have already given birth to nearly three litters of babies in the amount of time I’ve already been waiting. That’s a lot of chipmunks.

Insurance companies around the country have a wide range of policies on Spinraza. While the FDA approved the medication for all ages and types of SMA, at $750,000 for the first year of injections, it is in the insurance companies’ financial interest to limit access to the treatment. So, they have come up with a wide variety of parameters that they are using to approve/deny payment for the drug. Some insurances say you have to be over 15 years old, other insurances say you have to have less than 3 copies of the SMN2 gene, while some say you have to have over two copies of SMN2. Odder still, some are saying that that they won’t pay for those who already use a wheelchair… or a ventilator… or have a last name that ends with “r.”

I have Medicare, so my insurance situation is even stranger. Medicare is requiring something called “Buy & Bill.” Administering hospitals must purchase Spinraza themselves and then Medicare, in theory, will reimburse it. However, under this current set-up, the financial responsibility/burden is on the hospital. And most hospitals are understandably hesitant to assume that risk because they know there is a chance that Medicare will not reimburse 100% of Spinraza’s cost.

Would you fork out nearly a million dollars for a medication if you weren’t sure you’d get paid back for it? Uhm, HELL no. And no one wants to be the bad guy that sends on that kind of bill to the poor cripples in the wheelchair. I may not be in marketing, but even I know that’s not good PR. So, because of this policy, those of us with Medicare are in limbo. We’ve got prescriptions, but no way to get the drug— it’s like having a ticket to the moon, only NASA is broke and all the space shuttles are in museums.

I’ve been told by folks at Biogen (the distributor of Spinraza), and at Stanford, that talks are happening behind the scenes to figure this out. But, as time goes by, all of us with SMA get weaker.

Being patient is difficult, especially for someone like me that doesn’t have a lot of patience from the start. After all, I can barely wait for a grilled cheese to come out of the pan before I take a bite. I hover over the stove like a drone— and I burn the roof of my mouth EVERY. DAMN. TIME. Who can wait for that melty cheesiness? I know I can’t. You’d think that the resulting soreness in my mouth would deter me from doing it again the next time, but I’m just not that smart.

I’m sure some of you reading this are aghast at the price tag associated with Spinraza— and are thinking that there is no need for the treatment to be that expensive. But, please don’t descend upon the makers of this drug with torches and pitchforks on my behalf.

A specialized medication of this caliber is years in the making. There are many costs that go into creating something like this. So, they need to recuperate what they have invested in it. Further, this isn’t a medication for diabetes or high cholesterol— only a very limited number of people can use Spinraza. So, each dose has to be expensive to make it worth their time. If there is no financial incentive to research rare conditions, like Spinal Muscular Atrophy, then no one would bother doing it. That’s a fact. Kindness and altruism doesn’t make the world go around— money does.

In the meantime, today I received this Spinraza welcome packet from Biogen in the mail. It’s a treatment organizer— like the planner I had in high school that I rarely used. This organizer also came with a decidedly cheap pen— emblazoned the Spinraza logo.

spinrazapicNo offense, Biogen, but it’s 2017. Who writes with an actual pen, anymore? And who carries a planner? No one.

And I’m going to be frank… Don’t be like Clark Griswold’s cheap boss that bought him that crappy gift in National Lampoon’s Christmas Vacation. At $125,000 an injection, you could buy me an iPad, instead.

I’ll be waiting. You know where to find me.

The DNA Don’t Lie

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It’s been a whirlwind few weeks since the announcement of the FDA approval of Spinraza— the first-ever treatment for Spinal Muscular Atrophy.

Considering I had never heard of Spinraza until a few weeks ago, it’s amazing how fast a new word can enter a person’s vocabulary. It’s like when we were introduced to the expression “hanging chad” during the 2000 Presidential Election. No one had heard of a hanging chad before, and suddenly it became the most important thing in determining how to count votes in Florida— which in turn would decide who would become the President of the United States. It was all anyone could talk about— like that one time when Janet Jackson flashed her boob at the Super Bowl.

In case you are wondering what a “hanging chad” is, it’s what happens when a person voting using a punch-out ballot doesn’t push the little circle all the way out of the paper.

It’s not surprising the 2000 election kerfuffle happened in Florida. Everything weird happens in Florida. Those people are so chronically dehydrated from their ridiculous humidity that they don’t have the strength or clarity of mind to do much at all— let alone punch out a ballot correctly. I know I can’t even remember my own damn name if the temperature climbs too high.

Anyway, it’s rather remarkable that Spinraza, a word I’ve never uttered until recently, I now say at least three or four times a day. That’s nearly the number of times I utter the word f#%$. So, yeah, that’s a lot.

As I’ve documented on this blog, previously, I’ve begun the process to get Spinraza. And, “process” is definitely a way to describe it. They aren’t just giving this stuff away— like it’s a free donut at Krispy Kreme or a cabinet position in the Trump administration. No, they want me to earn it.

Today, I’m one step closer to achieving this goal. To qualify, a big component is having a DNA test on file showing my SMA gene configuration and my number of SMN2 copies. This is required because Spinraza may only work for those who meet certain parameters.

While a DNA test has been the standard way to diagnose SMA in recent years, I had never had this done before. I was diagnosed by muscle biopsy as a toddler, instead. I still have a two-inch white scar on my left thigh as a memento of the occasion. Good times.

Even if I had wanted it, DNA screening wasn’t around when I was diagnosed in the 80s. Yet, we did have lots of other things worthy of note that decade— like Cabbage Patch Kids… the Berlin Wall… and Bill Cosby before we found out he was such a pervert.

But, today, I’m one step closer to achieving my goal. I just got my DNA results and… *drumroll please* … It’s official, I do have Spinal Muscular Atrophy! And 3 copies of the SMN2 gene!

I know that may sound anticlimactic. But, I suppose it’s good to know I just haven’t been faking this for the last 35 years. I really am disabled. Yay, me!

Now that this hurdle has been cleared, I move on to the next step… getting insurance approval. Given the revolutionary nature of this treatment, and the limited folks that can use it, it comes with a hefty price tag— $750,000 for the first year… $375,000 per year, thereafter.

Yes, you read those numbers right. It’s not a typo.

My doctor at Stanford expects insurances to fall into line, but there’s no guarantee. So, keep your fingers crossed for me. I’m gonna need it.
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XOXO

A New Frontier

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Santa Claus and his most bureaucratic and boring reindeer—the Food and Drug Administration—bestowed a gift to the Spinal Muscular Atrophy community this past Christmas by approving the first-ever treatment for the genetic condition. The gift comes in the form of a liquid that gets injected into the spine using a really long and pointy needle. While a chewable pill (a la Flintstone’s vitamins) would have been preferable, I suppose crippled beggars can’t be choosers.

It is estimated that only 1 in 10,000 babies born have Spinal Muscular Atrophy (SMA)— including me. It is the #1 genetic killer of children under two years of age. But, there are a minority of us that manage to live well into adulthood, although our physical strength does slowly deteriorate over time and our life expectancy is abbreviated, or truncated— like Trump’s hands.

One in 50 people are genetic carriers of the condition, but since it’s a recessive gene, it takes two copies of the faulty gene to actually cause SMA. Carriers have one bad gene copy and one regular copy. So, to have a kid with SMA, two carriers have to get together. Even then, there’s only a 25% chance their child will end up with SMA (also known as the fuzzy end of the genetic lollipop).

In those of us with the condition, our SMN1 protein coding genes (located on the 5th chromosome) are, in all honesty, kinda fucked up. This protein is essential in muscle development and maintenance. Without it, we must rely on alternate SMN2 genes as our only source of this essential protein. But, these alternate genes are notoriously wonky and unreliable— like the U.S. Congress.

This newly-approved treatment, Spinraza (nusinersen), is an antisense drug that aims to give the alternative SMN2 genes an extreme makeover— turning them from faulty backup genes into fully functioning supergenes. It’s like what would happen if you grab Charlie Sheen, take his drugs and hookers away, and force him into rehab by tying him to a hospital bed. Eventually it’s going to have an effect on him, right?

Well, that’s the idea of Spinraza. In theory, it’s a pretty great concept. And, in clinical trials with small kids, it’s had miraculous results. Kids that should have died, didn’t—and some showed improvement in muscle function and strength— achieving unexpected milestones.

The FDA approved this treatment for all ages and all types of Spinal Muscular Atrophy. Trial research focused on infants and young children, but treatment has been expanded to include teens and adults. This isn’t a cure-all, and it’s important to note that adults won’t see as dramatic results as the kids do. The data is still coming in, but this is a promising beginning.

This week, I head to the Stanford neuromuscular clinic to discuss Spinraza and see if it will be possible and feasible to get the treatment. Given that it must be periodically injected into the spinal fluid like an epidural, it won’t be an easy undertaking and the results are still uncertain.

I have dueling emotions about this whole thing. I’m optimistic and hopeful— but I don’t want to end up like this year’s Atlanta Falcons, who thought they were totally gonna win the Super Bowl until Tom Brady and his hot manliness came and stole it all away.

When you live your entire life with a disability, it becomes a part of you, shaping your identity, your view of the world, and your own place in it. I wouldn’t be “me” without it. Before this bombshell Spinraza news at Christmas, I never thought there would be a treatment for SMA— at least in my lifetime. I never even imagined it. So, it’s hard to fathom that it may be true.

I’m sure folks in 1969 felt the same way about the Moon Landing. You can’t imagine a man on the moon until you see Neil Armstrong awkwardly toddling around on its chalky surface— like an 18-month-old at Chuck E. Cheese.

We will see how things go. I’m quite nervous and anxious about it. But, if it is logistically feasible to pursue Spinraza, and if there is a chance that it can extend or improve my life, I’m going to give it a go.
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Wish me luck… And, I’ll keep you posted.

XOXO