Two years ago, Tanya Pyatt, a human resources specialist, had surgery to remove a brain tumor. Just hours later she had a massive brain bleed and needed additional surgery. Tanya went home after rehab, but a massive headache sent her back to the hospital. There, a CT scan revealed a blood clot and doctors put her on Pradaxa, a highly effective blood thinner.
“Pradaxa was working for me but when I needed another medical procedure, they stopped giving me the medication and I got more blood clots in my brain and my sinuses,” says Tanya. “These aren’t normal, they’re really large.”
Unfortunately, Tanya’s insurance didn’t list Pradaxa as part of her coverage. “I had to pay $600 for each prescription. My mom would go with me, and she’d be crying and even the pharmacist cried. It was impossible to afford.”
How Christina advocated for Tanya
Christina Trifanoff, who is based in Phoenix, Arizona, is a registered nurse and certified case manager on a 70-person medication therapy management (MTM) team which supports a large national employer group. As the only nurse on the team, among other things, Christina works closely with Caremark pharmacists and fields dozens of calls daily.
“Tanya told me she’d repeatedly been denied coverage,” says Christina. “She said her doctor even wrote a note stating that due to the location of the blood clots in her brain, failing to have Pradaxa would mean death.”
Knowing the need was critical, Christina moved quickly. “I reviewed all of the information and reached out to speak to every person who had touched the case. I then called Tanya’s neurosurgeon.”
Christina provided the office with details of the denial and thoroughly explained how to submit additional documentation for review.
Within two days, the lifesaving medication was approved. “We cried when we got the news,” says Tanya.
“I’ve never met a more compassionate and caring human being in my entire life,” says Debbie Shartle, Christina’s manager. “In this country health care is so disjointed, and when you are sick it’s even harder to navigate the system. Christina knows how to be persistent and to connect the dots for her patients.”
“What Christina gave me was care on a way higher level than just ‘let me check on the status for you,’” adds Tanya. “I’m incredibly grateful.”
Today, not only is Tanya free from worry, but something wonderful has happened. Since being on Pradaxa her blood clots have been shrinking. And that news puts a warm smile on Christina’s face.
Thank you, Christina, for being a caring and persistent advocate for your members.