HOUSTON, Tex. – David Thompson is a fighter.
He fought and beat Stage IV Non-Hodgkin’s Lymphoma and then had a stem cell transplant.
That transplant gave him a 50% chance of long-term survival.
But, he was approved for a clinical trial at MD Anderson in Houston for the drug Keytruda.
Doctors say that drug could potentially bump his chances of survival up to 80%.
David’s wife, Kathy Thompson, said doctors told them he must start the drug within 60 days of his stem cell transplant. That would be next week.
But his insurance company, Blue Cross Blue Shield of Oklahoma, had denied him coverage for the clinical trial even though his policy has that benefit.
The cost of the actual drug is being covered by the trial sponsor, but the Thompsons needed Blue Cross Blue Shield of Oklahoma to cover the related patient care costs during the trial for things such as hospital stays and lab tests.
The family tells News 4 that David Thompson made it to MD Anderson in Houston Thursday and will be able to receive his first round of injections for the clinical trial. However, their fight is far from over.
The Thompsons say Blue Cross Blue Shield has only approved him for one month of the 18-month trial.
During their battle, Kathy took to social media with the hashtag ‘Approve David Now,’ and it’s taken off like wildfire.
“The hashtag ‘Approve David Now’ is trending in Oklahoma, so I think that my kids should be proud that their mom who just now got a Twitter account is trending,” Kathy said.
Kathy said they’ve been with Blue Cross Blue Shield of Oklahoma for about three decades, faithfully paying premiums the whole time.
She’s fighting for her husband, but also for other families.
“If Blue Cross can deny us a covered benefit, they’ll deny any of you a covered benefit,” Kathy said.
Blue Cross Blue Shield of Oklahoma sent News 4 this statement Tuesday:
“At Blue Cross and Blue Shield of Oklahoma (BCBSOK), we understand the concern of any member facing a health crisis. We know that every minute can count when it comes to providing treatment. While we cannot give specifics on this member’s case, BCBSOK is actively working to facilitate discussions with the member and the health care provider. As a member-owned company, our role is to advocate for the member – and that is what we are doing.
In the case of clinical trials, BCBSOK covers the usual and routine patient care that customarily would be provided outside of a clinical trial as long as the services are considered medically necessary for members who are enrolled or participating in a clinical trial. This includes items such as hospital visits, imaging or laboratory tests, and medications.
In the case of clinical trials, BCBSOK does not cover the investigational treatment, device, or service itself, which is typically covered by the trial’s sponsor, such as the National Cancer Institute or a pharmaceutical company; items and services that are provided solely to satisfy data collection and analysis needs and that are not used in the direct clinical management of the patient; or a service that is clearly inconsistent with widely accepted and established standards of care for a particular diagnosis.
BCBSOK has case workers that engage with members to work through benefit coverage issues to provide high-quality care to its members and to help navigate through the health care system.”