regular check-up, plus a bonus health insurance rant!

I was considering skipping this update because there’s nothing much new to report and I didn’t have that much to write. But it turns out I had a lot to say. This is why I tell my students that writing is a way of thinking: You don’t wait to write until you know what you think; you write to figure out what you think.

We had an uneventful 4-month check-up in Pittsburgh yesterday. Well, I did develop a UTI right before going to bed on Monday night, so that was eventful! (Why do such problems always pop up after all the clinics are closed?) I took over-the-counter meds -- thank goodness I had some on hand -- to get me through the night and the drive to Pittsburgh. Then my oncologist wrote a script for antibiotics, which we picked up when we returned to State College. I’ve discovered that UTIs are a common side effect of Tagrisso. I had one in my entire life pre-Tagrisso, and in the past 2.5 years, I've had at least 4 (a month of recurring UTIs in 2023, last September, and now). Fun times.

This visit also reminded me why I do not read the CT scan report before seeing my oncologist. She asked if I’d been sick recently, and I confirmed that I had a cold after Thanksgiving. She pointed to a new spot on the CT scan and mentioned that it was noted in the radiologist’s report. “A 7 mm nodular density within the superior segment of the right lower lobe on image 94 is new since prior exam.” Dr. Villaruz suspects this is leftover gunk from my cold. And this, my friends, is why I do not read the report beforehand! Reading about a new nodule would certainly have freaked me out – and for no reason.

My scans are stable, and I will return in 4 months. December 30 will mark 3.5 years on Tagrisso, my miracle medication!!

Every 1.5-2 years, I get a brain MRI. This was clear, although many questions remain about how my brain operates.

Finally, on January 1 PSU is switching from Accredo (which I hated because of their general incompetence and many errors) to CVS Caremark for “specialty” medications. For expensive medications like Tagrisso and Enoxparin (my blood thinner), you can’t just pick it up at your local pharmacy. It must go through a specialty pharmacy and is mailed. The switch is supposed to be a “seamless” process, yet I spent about 1.5 hours last week on routine phone calls with AstraZeneca (the company that makes Tagrisso), CVS Caremark, and PrudentRx (a company that can save $ on specialty medications) going over my basic information, medication names and dosages, etc.

Through this, I discovered that Accredo messed up yet again. They lost my blood thinner prescription in September or October, so I had called my hematologist for another prescription the following month. That newer prescription has now disappeared (I should still have refills remaining, but there are none). Only prescriptions with existing refills will transfer to CVS. Hence, in January I will have to call my hematologist again to ask for yet another new prescription.

Accredo also started charging me $50 for Tagrisso the last 2 months. Until now, it has been free because it’s covered by insurance, and the remaining $50 copay is covered by AstraZeneca’s Access 360 program. The AZ rep told me that my Access 360 account should automatically be covering that $50, but for some reason Accredo is still charging me. Accredo also randomly and inexplicably over-charged me by $90+ for my blood thinner, so I am fighting that. I have sent more emails to the PSU Highmark concierge who troubleshoots all these issues for me. We are also fighting a large bill of Leland's that insurance won't pay, plus a $500+ charge for Lily's (negative) mono test at Mt. Nittany months ago, something that cost a nominal amount at our private practice doctor in 2024. Our long-time doctor, Dr. McCleary, was driven out of business by Highmark's low reimbursement rates for private practice and started working at the VA Hospital in Harrisburg. We are still devastated. :(

Anyway, if the $50 Tagrisso co-pay will no longer be covered, then I will go from paying nothing for Tagrisso to paying $1200/year, because PSU decided to increase the cost for specialty medication co-pays from $50 to $100/month.* So there goes a big chunk of my small raise, which was just barely above increased cost of living. By contrast, President Bendapudi got a 50% raise of $450,000 plus all kinds of other monetary benefits.

*I and a few other members of the Faculty Benefits Committee have repeatedly pressed PSU to charge people who make $200K - $300K/year the same percentage of their income for healthcare premiums as everyone else. The answer is always a hard no, and the same reason is always given: “We have to remain competitive” in attracting employees (read: the highest-earning employees), and they might decide to work elsewhere if health insurance premiums are too high.

PSU pegs the premium to the health plan you choose and your salary (the less you earn, the less you pay), which I wholeheartedly support. These high earners (above $200K) pay a higher amount in absolute dollars, but as a percentage of their salary, it’s much lower. For instance, employees with our insurance plan and family coverage pay 5.51% of salary for monthly premiums. For someone making $75K, this is $344/month; if you earn $200K, it’s $918. Everyone who earns over $200K (including the new and former football coaches) also pays $918. For someone earning, say, $300K, that is only 3.06% of annual salary.

Penn State’s insurance costs are rising for many reasons (including federal government cuts to Medicaid and the cost of GLP-1 medications). However, I have long argued that making higher earners pay their fair share could help offset the costs for everyone else. Instead, those of us whose lives depend on specialty medications will have to pay more. Our family will almost certainly pay more on top of that because the out-of-pocket maximum is also increasing, as is the cost for going to the ER (from $100 to $200). We obviously try to avoid the ER, but last year I had to go twice because of my knee--another health crisis that happened when doctors’ offices and express clinics were closed. It is infuriating to hear some HR reps imply that people use the ER glibly rather than using less expensive options, and that the higher charge will make us think twice and make more financially responsible decisions.

So, all told, our family might end up paying thousands more dollars in healthcare in 2026. We have insurance and can afford the higher costs, but many families either don't have insurance or can't afford the increased costs.