A Cape Coral couple almost had to make the difficult decision of staying in their marriage or getting a divorce all over the cost of prescription medication. WINK News Health and Medical reporter Veronica Marshall explain what may have gone wrong so it won’t happen to you.
Through their 30 years of marriage, the Kanz have fought side-by-side facing challenges together.
“He’s been going to a pulmonologist because he’s had COPD and emphysema,” said Carol Kanz.
“She has cancer in her blood,” Thomas Kanz said. But, this latest health battle has threatened to rip their relationship apart.
Earlier this year, doctors diagnosed Thomas with Pulmonary Fibrosis, which causes scarring in the lungs and makes it difficult to breathe.
“I can’t walk 100 feet without stopping. I just lose my breath,” Thomas said.
“What makes it tragic for us is that his older sister died of this in 2015. And she went pretty quick,” said Carol.
This is a progressive condition that can’t be cured. But, through treatment, it can be slowed down. The medication, however, is very expensive.
“We found out the copays are over $27,000 for a 90-day supply,” said Carol. “I mean…there’s just no way you can do that.”
Thomas wonders who out there can afford that. “I mean…who can? Unless you’re a multi-multi-millionaire and believe me, we’re not,” he said.
All of their applications for financial assistance have been rejected.
“She said ‘Oh no, what was your annual income last year?’ And so we gave them the income, and she said, ‘Oh no, we can’t help you, you don’t qualify,’” said Carol.
In an effort to afford the medication, they were facing a devastating choice. Stay together and not be able to afford the medication or get a divorce, divide their assets and be able to afford their medication.
“We were considering divorce. If it comes down to that and we can do it legally, then that’s what we’re going to do. It won’t change anything for us, but…I think that’s cruel,” Carol said. “I really think it’s cruel to do that to people.”
“We don’t know where else to go,” said Carol. “We’re hoping.”
Jonathan Hess is with Athos Health. “What I tell people is always start with the manufacturers. It’s the highest probability of success,” said Hess.
Drugmakers want to help families afford their medication. “Go to the manufacturer’s website and fill out a form. It’s usually pretty simple, four or five questions, address, name, household what their adjusted gross income is,” Hess said.
“And if it’s under $100,000 then it will be covered in a heartbeat. They’ll get instant coverage. If it’s just over $100,000 – they may have to appeal it,” said Hess.
For the Kanzs, Hess says, their requests were denied due to a simple mistake. Because, while some financial assistance foundations require your gross income, drug manufacturers don’t.
Hess said, “After I found no, you should use adjusted gross income and had a conversation with her, she reapplied using adjusted gross income, which was below the threshold. And she got accepted.”
Then, “About 30 minutes later, I got a call from her, basically in tears,” Hess said.
Carol says it was a Christmas miracle. “We couldn’t be more thrilled. For us, it’s like a Christmas miracle,” she said. “Oh yes, definitely. Definitely.”
So now, the Kanz can look forward to even more years together as husband and wife.