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Managing the Costs of CLL Treatment

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Published on July 8, 2020

Key Takeaways

It is important to talk to your doctor if treatment expenses start to become to much.


Clinical trials often cover drug costs


Pharmaceutical companies and the Leukemia & Lymphoma society have financial assistance programs.

Managing the Costs of CLL Treatment

CLL treatment can be expensive — particularly over time and when it's treated as a chronic condition. From drug costs, co-pays, IVIG, traveling expenses and lab work, the pinch of treatment costs are felt by many people living with chronic leukemia. Is there a benefit to fixed duration therapy and can it keep costs down? Are there financial resources available to help?

In this CLL Answers Now program, host Andrew Schorr talks with two other CLL patients, Linda Weiser and Jennifer Abraham about their experience dealing with CLL treatment-related expenses and what they did to save money. They are joined by Dr. Thomas Kipps of UC San Diego Moores Cancer Center and Dr. Jennifer A. Woyach of The Ohio State University to discuss where cost concerns come into play when making treatment decisions. Tune in to hear the full conversation.

This program is sponsored by AbbVie, Inc. and Genentech, Inc. These organizations have no editorial control. It is produced by Patient Power. Patient Power is solely responsible for program content.

Featuring

Transcript | Managing the Costs of CLL Treatment

Andrew Schorr:
Greetings, welcome to this CLL Answers Now program. I'm Andrew Schorr joining you from North San Diego County and I am very appreciative of financial support we've had for this program — they have no editorial control — from AbbVie and Genentech. Thank you so much. And we have this every two weeks series of CLL programs. We're talking about how cost comes into decision-making related to CLL treatment and here come my friends. So, let me introduce you to this expert panel. First of all, in Indialantic Florida is my friend Linda Weiser, Linda dealing with CLL since 2010. Linda, thanks for joining us.

Linda Weiser:
Hi Andrew.

Andrew Schorr:
Okay. And also let's skip way over to Boston, another patient, Jennifer Abraham. Jennifer, thank you for being with us.

Jennifer Abraham:
Thank you for having me.

Andrew Schorr:
Okay. And then we have two noted CLL experts, one of them happens to be my doctor right here at the Moores Cancer Center at UC San Diego, Dr. Tom Kipps.

Dr. Kipps:
Hello.

Andrew Schorr:
Tom, thank you for being with us.

Dr. Kipps:
Thank you. Thank you, Andrew.

Andrew Schorr:
And then another noted leukemia center and a CLL specialist at Ohio State The James, there is Dr. Jennifer Woyach. Dr. Woyach, you for joining us. Okay. Let's talk to our patients first. So first of all, Linda diagnosed in 2010, you're in a clinical trial, and then you'd been in the defense industry, but ultimately dealing with CLL. You went on disability, but ultimately ended up on ibrutinib (Imbruvica) paid for, but you're also getting IVIG and I understand the IVIG has been maybe helpful, but financially painful. Tell us about that.

Linda Weiser:
Yes. When I first started getting the IVIG, Andrew, it was once a month. And from there, that's pretty costly. Because of my insurance, I pay 20%, it comes out of my pocket. So every time I have an IVIG infusion, it costs me between $400 and $500 because it goes by weight, I guess. So depending on what they use. So, I went to my doctor to see if I could push it back to maybe once every other month. And he said, "Yeah, that was fine." And now just recently, I guess, in light of all the COVID going on, he's come back to me and said, he'd like to do it every six weeks. So, I'm fine with that given what's going on because the cost can't be what decides your treatment. You've got to do what's right.

Andrew Schorr:
Right. But the out of pocket cost is painful though for sure.

Linda Weiser:
Yes it is and something else I thought about was I chose to do it with my local oncologist in his office because it's close by. But also it was a little cheaper here than if I actually went over to Moffitt and did it because it's a big hospital, the copays, everything was going to cost a little bit more had I gone to Tampa.

Andrew Schorr:
Okay. Want to go to Jennifer Abraham in Boston. So, Jennifer, you've been dealing with CLL since what year?

Jennifer Abraham:
2013.

Andrew Schorr:
Okay. You've had a rough go. So you've been on clinical trials, you've had side effects. You've been in the hospital. You're now on the venetoclax (Venclexta), and it is paid for. You do have insurance, but it wasn't originally that. And I understand when your doctors thought that was the choice for you, you were kind of in a battle with the insurance company and getting a home equity line for your house to try to come up with the money to pay the copay, right?

Jennifer Abraham:
Well, my CLL diagnosis was my third cancer diagnosis and I was 48 years old. So I was completely devastated by that. I didn't know what was going to happen and because of the prior cancers, one being melanoma and one being thyroid cancer, my doctors and I had a team, I was all over the country. But they didn't think that Imbruvica was my best option. And I'm an unmutated and I have all these crazy things with it. It started to just grow and take over. And I had really been waiting for venetoclax to be approved for frontline, but it wasn't. So I was literally writing letters all the time. What happened was my spleen got too big, it was 20 centimeters and they didn't want to do surgery so that I had to start the Imbruvica.

They did not want to do that. They said, if I wanted to pay $10,000 a month, I could get on the venetoclax and they said I probably would need a year or two. So I actually took a home equity line of credit. I didn't get as much as I wanted and I would've only been able to go a year. The doctor thought I would possibly need more than a year. And in the end, I chose not to do it because I have two young children. I'm a single mother. It was having to make that decision, I have to be honest was probably the most difficult decision of my entire CLL diagnosis. Having to think maybe I wasn't making the choice that was recommended by three of the top CLL specialists. I'm sorry. And instead, having to go with the other drug, which is fine for a lot of other people, but again because of my prior cancers, that wasn't really a great option for me.

Andrew Schorr:
Right. Let me mention to our audience and I'm sorry, Jennifer, I know it's emotional for you. The point of this is to discuss how we can make wise decisions with our doctors and we have two of them here. We're going to talk to them in a second and what assistance there is or what insurance approvals we can get wherever. So we can afford the treatment we need and deserve. I do want to tell our audience, we kind of have some happy endings now. Linda in Florida, you're doing well with your IVIG and your Imbruvica, right?

Linda Weiser:
Yes.

Andrew Schorr:
You're doing well?

Linda Weiser:
So far, it's working.

Andrew Schorr:
Right and Jennifer in Boston now on the venetoclax or Venclaxta, you're doing well, correct?

Jennifer Abraham:
I'm doing well. Yeah, I just got off a clinical trial, but I'm doing well on this venetoclax right now.

Andrew Schorr:
Okay. Let's go to the doctors. All right, Dr. Woyach, so these financial issues are real. The medicines are expensive, even whether it's IVIG. I happen to be on Medicare. So that's one profile. Linda's now on disability, so she has some Medicare support. Jennifer, I imagine you have a commercial insurance, and we have some people watching who have military insurance. So it's kind of, it's like a sticky wicket in a way. So how do you make clinical decisions, Jennifer Woyach, with your patients on what you want to do to help them with their CLL and what's affordable?

Dr. Woyach:
Like you say our patients have said, these can be very difficult situations. And certainly, I think the biggest point I want to make is that this is something that really should be discussed every time between a patient and their doctor. And I don't want any patients to feel like that's something that they shouldn't be bringing up, that shouldn't be a conversation that happens back and forth. I think insurance companies are difficult and they're all different. And we as physicians don't usually know, is this company going to pay for this drug? Is this company going to give this percentage of their costs? So sometimes we have to be a little bit flexible and we think about what are the options for treatment for an individual patient and luckily in CLL there often are more than one option.

And then we think about what is our ideal scenario? Is this patient best served with venetoclax or obinutuzumab (Gazyva)? Is this patient best served with ibrutinib? Is this patient best served with acalabrutinib (Calquence) and then kind of work on all fronts to make the decision that is also going to be affordable for the patient. And some patients we don't get to do the first thing that we want to do because of insurance situations or because of high copays, but there's always something else that we can think about. The only other thing I wanted to mention too is, we should think about clinical trials in every scenario, but many times clinical trials will pay for all of the drugs involved or at least some of the drugs involved. And those can actually be very good options for ways to get drugs paid for.

Andrew Schorr:
Okay. Those are all good points, we'll come back to that. Dr. Kipps, now you're my doctor, what about the decisions, not just for me, but for your many patients who come from far and wide on where cost comes into play and yet trying to do what's right for the clinical situation? What's your point of view?

Dr. Kipps:
Well, I agree with what Dr. Woyach said, when we practice medicine, we look at the patient, we develop an interaction. We want what's best for the patient and there's many factors that go into deciding what are the best types of treatment. And there's not any one way or one-size-fits-all. Not only is the issue of the genetics of the disease and the tempo and other factors, but also other medical conditions and what other treatments are they having to take? And what other difficulties are they facing?

For example, how difficult it is to get to say an infusion room? And then there's also the aspect of insurance coverage and we, as doctors, would like very much for people to have insurance provided to them and not be denied insurance because of the fact that they have CLL or some other medical condition. And we've been very much trying to champion that, but I think it's apparent that not all insurance coverages are the same and I'm hopeful that there'll be increased regulations so that people don't get saddled with insurance policies that fall short of providing treatment for this type of leukemia. I do think the situation has gotten better and it's gotten worse. In other words, before when these drugs that we're now using only were available in specialized centers and under clinical protocols, we had a lot of people being forced into types of therapy, which may not have been most beneficial to their health.

And there was some economic issues that also factored into that. I think with the advent of these new drugs we have, we now see patients that are doing much better than they would have done in the past with chemo-immunotherapy, but then oftentimes they're put on regimens that may last forever, and there may be the issue of copay and even a small amount each month adds up. And it's almost like taking on a second mortgage for some patients. I think what's very important is that as Dr. Woyach mentioned as doctors, when we interface with the patient, we ask how you're doing, what other problems do you have? We take note of any side effects you're having, how well you're tolerating the drug, how well it's working. One thing we don't ask too often is how are you handling the costs? We don't really engage in that discussion as often, and it's really not in our wheelhouse to be able to be as aware of that and that's unfortunate.

So I think as a patient, it may be worthwhile to bring this up with your doctor because it may not come up in the conversation. In other words, there could be a cost factor and the doctor may be unaware that you have a peculiar insurance policy that denied coverage for this or that. And I think that's important because there are some remedies to this. We have access to each one of these drug companies do have foundations that you can apply for and depending on your financial need, you may be able to get the drug at a markedly reduced cost. And then there's also other things we point to, we work with the Leukemia and Lymphoma Society. And they also have provided benefits, whether it be travel or potentially help with medication and the like. And I would like to suggest that patients in need, may be able to apply to the Leukemia and Lymphoma Society and patients who are doing well and can afford it, may want to donate to the Leukemia and Lymphoma Society. So that as a group, we can kind of help each other. I think that's always very good.

And those types of things are very important, but if you don't even bring it up in the conversation and suffer in silence, and you're taking out a second mortgage and you're going through all this financial, which is adding to the stress of having leukemia. It's bad enough, you have a life-threatening disease, now your whole life is being put on the auction block and you're having to worry about your kids and your kids' future. It's a mess. Some years ago, we had the opportunity of writing an editorial and there was quite a few people involved and Dr. [inaudible] was at the Mayo clinic who was the lead author on that. We tried to appeal to drug companies to keep the costs down and I think unfortunately that hasn't played out as well.

I do know there are good people working in the pharmaceutical industry that really do want to make a difference and improve patient's lives. But unfortunately, it's also the market aspect of running a business and people who have no knowledge of disease or patients are sometimes dictating how much these things are costing by what the market will bear. So these are forces that we probably could mitigate if we were able to get better communication.

Andrew Schorr:
First of all, I think what Dr. Kipps brought up about you bring it up with your doctor. And he's at a major center, Dr. Woyach is at a major center. Many of you go to major centers, but not only, but increasingly now there are financial navigators who can help you.

We at Patient Power have done a number of programs. If you look up on our website, Dan Sherman, Dan's been on a number of programs. He's been training oncology financial navigators around the country. And so there is assistance sometimes even with paying your rent, sometimes being in the logistics of being in a clinical trial and the travel and getting a babysitter, paying for groceries.

Now, Dr. Woyach, I did want to touch on something that Dr. Kipps just said, and that is with the newer medicines, some you might take forever. Although I know at Ohio State and at UCSD have trials seeing are there new combinations? And then others that are time-limited or fixed duration. So that might go into the decision of cost as well. Like Dr. Kipps says, there's a copay and it may go on for an extended time, or there's a copay that may be a shorter time.

Dr. Woyach:
Yeah, I think one of the promises of these fixed duration therapies is that we could limit both costs and also of course toxicity that comes with taking any medication for a prolonged period of time. I think we still are studying these in clinical trials. So, things like combining a BTK inhibitor, like ibrutinib or acalabrutinib with the BCL-2 inhibitor, like venetoclax, that's something is really appealing to maybe get patients into a very deep remission and be able to stop treatment. But of course, still in clinical trials, because we don't know how long those remissions are going to last.

And I think you have to think about costs not only during two years but really over the course of a patient's next 10 years or even their entire lifetime. And many of these fixed duration regimens are more expensive upfront, and I think we'd need more data and more analysis done on these different regimens to know whether a fixed duration treatment that is much more expensive in the short term is going to pan out in the long term by decreasing long term costs if patients are in a long enough remission that they don't need additional therapy.

So if you did a fixed duration regimen, that is double the cost of ibrutinib for example, and then you take it for a year and get six years where you don't have any treatment, that's obviously going to really decrease the cost. But if you do a fixed duration regimen and get two years remission duration, and then have to go on ibrutinib anyway, the equation gets a little bit different.

Andrew Schorr:
Okay. Yeah. Well, these financial navigators can help see what assistance there is, but obviously, some of your response to a clinical approach will vary and you as doctors don't always have a crystal ball to know how that patient is going to react for how long. Like Dr. Kipps, you've been an investigator of venetoclax and I'm sure you've seen responses all over the map, right? Some people maybe have had a long period of no treatment and some people less so, right?

Dr. Kipps:
A lot of research is now being done to try and figure out maybe we can predict which patients are going to be most able to respond. Many patients respond very effectively and can be with even a year or two of therapy get into a very long-lasting remission without having to need to take drug. And we've been studying the drug for some time. I think we're privileged to be, I think the first to give venetoclax in the country, a fourth patient worldwide on the phase one trial and I was impressed very early on that it was a very active drug and one that's almost too active at the beginning. It's like an ice cream freeze. If you take too much, when you have a lot of disease, you can get in trouble. But then after you get onto the dose of medication that's considered the optimal dose, many patients are able to take it without many side effects and that's been really reassuring to see too.

I think that I agree with what Dr. Woyach said, we have to try to factor these things in and this has all come at such a rush. These drugs have just recently been approved and I think that it's still uncertain as to how to map out the most effective and cost-effective type of treatment. I do think that there are some treatments we've used in the past and in particular, I know the treatments which may be personally applying to you that we should remember because there are some very useful treatments that are tried and true that can actually mitigate some of the problems we have.

I'm not a big fan and never have been of chemo-immunotherapy. Although I think with anything, some of the agents that we've had in the past, aside from chemotherapy too, can be very effective in the right clinical setting. And I think like anything I've said, a surgeon's scalpel can be a dangerous tool if given to a two-year-old, but if you put it in the hands of a surgeon, they can get the job done. So, we have to take into account how we use these agents. How do you use them best and use them to mitigate the toxicities and the problems that patients have? So these are very important factors and again, I just want to emphasize again for people to express what they're going through if they can, so that help can be identified.

Andrew Schorr:
Right, and I want to bring up and I want to bring Linda and Jennifer Abraham back in the conversation. So it's not just also your CLL medicines, a lot of you may be on other medicines too. Dr. Kipps is well aware, I have another blood cancer called myelofibrosis and I take this medicine fedratinib (Inrebic) in my copay because I still work, is $986 a month. Okay? So where does that go in? Should I be on another oral therapy for CLL?

First of all, could I qualify for some assistance? And I will say and your financial counselors at UCSD did look at this with me with the drug company, it wasn't just a question of what was the copay for their drug. This particular company, which is now Bristol-Myers, takes a look at your overall prescription drug expenditure to determine, can they provide a drug for free for you.

Linda, we had questions about disability. Somebody was wondering, "Well, how do you make the decision to go on disability?" How has that worked out for you? Was that a difficult process for you to qualify for disability and then get assistance for that?

Linda Weiser:
It took a little bit of time to get on it. I got pneumonia at my job right before I left. They offered an early retirement package. I took it because I knew it was going to be time for me to start my treatment and I didn't know what was going to happen when I did the clinical trial when I started in 2013. So I made the decision to try out for disability and I was able to get it and there's help with disability. There's something called like, "Medically Needy," that they help a lot of times and that's helped with my different drugs. Like I said, with my ibrutinib that would normally be around $11,000 a month. I have a copay of $8 in January and then I don't pay anything the rest of the year. So I mean, it really does help. There are programs out there that can help you.

Andrew Schorr:
Okay. And just to be clear, the disability, is that through the Social Security Administration?

Linda Weiser:
Yes. Yes. Because CLL is one of what they call compassionate diseases on the list for getting disability.

Andrew Schorr:
Okay. And Jennifer Abraham, so you had to wait for venetoclax or Venclexta to be covered by your commercial insurance as an earlier therapy, right? And then you get it for free or how has it worked out?

Jennifer Abraham:
So I get it for free. I also got my ibrutinib for free. I didn't even have a copay. Yeah, I do get it for free, but I know that my doctor and their whole team wrote many letters to the insurance company saying that I needed it. They were amazing when it came to that. They all stepped up.

Andrew Schorr:
Okay. So let's go back to Dr. Woyach. So I know your job is to do research at Ohio State and provide clinical treatment for CLL patients. Sometimes though, do you find yourself having to write letters and call medical directors at insurance companies to go to bat for your patients so they get what's right for them?

Dr. Woyach:
Oh yeah, absolutely. Probably more often than I would like to do, but yeah that's something that's important to do. We need to find what is the best treatment for our patient and then do everything we can to make that happen.

Andrew Schorr:
Okay. And I'm right that at Ohio State there at The James, you do have financial navigators, just like they do at UCSD?

Dr. Woyach:
We do. Yeah. We have a really amazing team that's made up of financial navigators, pharmacists, more dedicated case managers that really, I mentioned before that I don't necessarily know when talking to a patient at first, how much they're going to have to pay out of pocket. As soon as I put that prescription in, our team figures out how much they're going to have to pay out of pocket and then goes through the process of looking for assistance programs, looking at copay cards and figuring out what we need to do in order to get that drug at an affordable price. And if that means that we have to write a letter or call somebody, then that's what we do.

Andrew Schorr:
Okay. I should mention that of course, bring this up, I can't underscore enough what Dr. Kipps said about bringing it up with your doctor and then they can help as your nurse did with me, Dr. Kipps, Sharon O'Mary, who I love, who's been your nurse for a long time. They can help then is there another player at the medical center who can come into play and help you navigate this? Now you have to disclose, you the patient, have to disclose not often a lot of information. And again, look at our other programs on Patient Power with Dan Sherman. It's pretty simple. Sit down with these people. You don't have a million pages of tax returns and all that, but there are free drug programs. There are assistance programs, as Dr. Kipps said from Leukemia and Lymphoma Society and other foundations, the Patient Advocate Network Foundation, and others that can help you.

There's Family Reach that helps with rent and other things you may go through and support for even being in a clinical trial. So Dr. Kipps, we have expensive medicines that cost a lot to develop too. I'm sure that's what the drug companies would say is they do trials with you and others, and there's a lot of red tape and there's a whole lot of stuff that goes with it, can be $100 million dollars. So we're faced with those costs but do you feel today in CLL that if people work with their doctor, work with these other healthcare teams, they can get what's right for them, they can get effective CLL treatment?

Dr. Kipps:
I can and it takes many different people to argue with this and like Dr. Woyach, I wish I had a nickel for every time I had to speak to an insurance adjuster that I would be able to pay for all the therapy of my patients. But, I think it's true that the insurance people are trying to toe the line, they're trying to keep costs down. I get it. But they're people too, and we can appeal to them and get approval for things. If we have a good plan and we have a rational reason for doing what we're doing, and it's on solid evidence-based medicine, we can make a strong case for the fact that this is the right thing for that patient to do. And that's very compelling when it comes to trying to get the insurance companies to provide it.

And also trying to work with these foundations to mitigate some of the costs. So, I do think… let's take one step back here. We're doing much better than we did a decade ago, and it's going to only get better, but we still have problems. And these problems and financial problems are real and they touch every one of us. And I think we need to be able to try and work together to figure out the best solution, recognize that not every pathway has to be just one pathway, that there are many. But try to get the pathway that is best suited to your health and to your disease and other conditions that you may have. It's not one-size-fits-all. And so we have to be able to size up all these factors and design the best course of treatment.

And it was mentioned with regard to IVIG, we do use this a lot. It's challenging to get insurance to pay for it. We've generally been successful in getting them to comply with me. I think they kind of groan when they know that Dr. Kipps is on the line. But, I think it can be a game changer, but if it's used at the right reason. For example, Linda was mentioning she had pneumonia and probably that was the basis for wanting to get with IVIG. Without it, we are more prone to pneumonias and other infections, particularly involving the ear, nose and throat and lungs. And IVIG, I've seen become a game changer for patients and so patients who have repeated infections and really their quality of life is suffering from it can improve tremendously with IVIG. However, it may not be just the number of the IgG level, but there's something about the fact that they have extra Ig, that they can now steer clear of the infection.

So you want to keep a diary of your infections. I think that's very important. Keep antibiotics at the ready so if you do travel or go outside your door, you have a course of antibiotics with you that you can start, being in discussion with your physicians. It will happen that we may get an infection, but if you keep a diary, I used the record of what the patients go through in terms of the number of infections they have. And we document how many infections they have on IVIG that's evidence-based. And the insurance company, I said, "Well, do you want this patient to die of pneumonia? I have evidence here that without it, they would suffer." So if it's just because IgG levels low, they may push back and not give you the coverage that you need.

So I think it's important again, to discuss this with your doctor and get the reasons that you have the treatment and have them spelled out and make a compelling argument for going forward.

Andrew Schorr:
That's well said. I'll just comment on IVIG, which you recommended for me after I was calling your nurse with recurrent infections. You had that record and I've been doing it religiously every month. We're going to have to close in a minute. Just one quick question for you, Jennifer Woyach and that is, could you explain compassionate use? Where does that come in as far as somebody getting access to a drug and what would the costs be related to that?

Dr. Woyach:
So it depends. A lot of times compassionate use is used in a situation where a drug is not FDA approved for that indication. In which case sometimes, the drug manufacturer has a program where that drug could be given for free for specific indications. Sometimes that has to be done as part of a small clinical trial at an institution and sometimes it's done by other mechanisms. But usually, in a compassionate use situation, it would be free.

Andrew Schorr:
Okay. All right, I'm going to get some closing comments for each of you and just underscore a couple of points before I do. First of all, look on patientpower.info and the programs with financial oncology financial counselor, Dan Sherman. And he's going to explain how that process works when it's handed off from the physician to these other people at the medical center to sit down with you based on what your doctor's recommending and figure out, how does it get paid for, with the least pain? Okay. So that's all there.

Also, there is a survey I hope you'll do as we end this program to help us know how we did. So Linda, what do you want to say to other patients so they get what's right for them and whether it's on disability if that's what they need, fight with the insurance company, speak up, see with their doctor their schedule to adjust out of pocket cost. What would you say?

Linda Weiser:
I just want to say that there are places you can go for help. You can go see your social worker at the major hospitals. I even contacted one of the drug companies. A lot of times they'll help you also. And use your social media, I'm a member of a number of these CLL groups, and there's people with great information in there that have maybe gone through the same thing you have and you can ask them questions and they can tell you, call this person or get in touch with that person and that may help too. And again, cost cannot be what decides your treatment. You got to look at all options to minimize your out of pocket expenses. So, you got to watch out for yourself.

Andrew Schorr:
Well, we wish you well. Thank you, you're an old friend. You're not old, but you're a friend of mine for a long time. Thank you so much.

Linda Weiser:
Thank you. I've enjoyed it.

Andrew Schorr:
And thank you, Jennifer Abraham, a closing comment from you what you want to say to other folks because you've had a windy road in getting to now venetoclax that's working for you and having financial wherewithal.

Jennifer Abraham:
Well, what's interesting and what I got from this and thank you very much is that - I'm a social worker by trade and the minute I got my first cancer, I've been advocating for myself for the last 20 years. And I will find a doctor and I will make myself an appointment and I will travel everywhere. But I never once thought about telling my doctor that I was really suffering financially.

It never occurred to me, Dr. Kipps to say, this is really a lot. I was in the hospital last year about 45 days and couldn't work and I think there's an element of pride there. And I couldn't say this is killing me every time I drive in and have to pay for parking and staying over and having someone watch my dogs. It never occurred to me. So thank you, Dr. Kipps for, we should, there's a barrier there, and I've never even thought about it before. So that's the one thing I'm going to say, just because they do care, the doctors, but you need to tell them.

Andrew Schorr:
Right. There's no shame and let's face it folks, lots of people unemployed now. Lots of people losing their insurance or under-insured, or no insurance. Work with your health care team and work with the drug companies and the foundations, for sure. Dr. Woyach, a final comment from you on this issue.

Dr. Woyach:
I'll just echo what has been said before, make sure that you talk to your doctor about what you need to get the best care. And medicine is a team sport so there's lots of people besides just your doctor who can help you out. Our teams of social workers, case managers, nurses, pharmacists, all of these people are available to help figure out what is the best thing that we can do for you.

Andrew Schorr:
Okay. Well, thank you for being part of that team and your work at Ohio State and The James. Dr. Kipps, my doctor and the doctor to so many others and been devoted to CLL for so many years, a final comment from you. What you want to leave patients with on this topic?

Dr. Kipps:
I think we're all in this together and we're a community and being able to communicate, we'll be able to work through this. I also want to touch upon an ancient Chinese proverb of four characters and luck is paired with wealth, but health is paired with happiness. So with health, we have happiness and we will be able to overcome all these obstacles by just discussing it and working on these problems. We'll get through it, have faith and I just want to thank you, Andrew. I really appreciate the work that you're doing, and this is a great service to the patients.

And I want to wish all of the patients out there really have faith, you will get through this. And the brighter days here are for everyone if we pay attention to these newer therapies and how to mitigate the costs.

Andrew Schorr:
Right. Thank you so much for your time. We're going to let you, Dr. Kipps and Dr. Woyach go. Thank you for your work in research for what's next for us. And also you're using current treatments wisely and cost-effectively.

Dr. Kipps:
I just wanted to say, "Hi" to Dr. Woyach. We haven't been having meetings in this COVID time. I think it's been strange, but it's good to see you again.

Dr. Woyach:
It's nice to see you too, even if just over Zoom.

Andrew Schorr:
We're all in it together. You all can pop your video off. I just have a couple of closing comments to our audience. So folks here's the thing, we're going to do these CLL programs every two weeks. We've been doing them, there are many to look at on the Patient Power website. We've had so many of the other CLL specialists around the country, even around the world on these programs. And then beyond that, we need your suggestions. So send them to cll@patientpower.info and there's a little survey that's going to pop up right as you leave this program. Takes like 30 seconds, do it. It really helps us know how we did today. Look at those programs with the financial navigators, ask for a financial navigator where you get care. So all of these programs that are available can be brought to bear for you.

Thank you so much for watching and I like to say knowledge can be the best medicine of all. Bye. Bye.

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