RE: [EXTERNAL] Injectable medication

Hi Lesley. Before we get started with the process, I need a copy of Mr. Epstein's recent labs including cholesterol with in the past 30 days. Please let me know if he does not have one so I can send an rx to get it done. We will try to get approval for his medication to avoid paying out of pocket and the company is willing to provide samples while working on his approval.

Please cal: to set up a training session and also $5 copay card if medication approved.

Please let me know if you have any questions. Thank you

Kristine

Great thank you. Dr. Shimony states he had recent labs just don't know what his definition of "recent" is. Should be within the past 30 days. Please let me know if any issues and contact by email or office number.

KK

Hi Kristine. Thank you so much for this. Let me find out from Jeffrey if he has lab work that includes cholesterol within past 30 days. I don't think he does but he has gone without me knowing before A. I'll call the number below to set up training. Have a good evening. Lesley

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I am so sorry if I can't respond right away since I am seeing patients with Dr. Shimony. I am on the phone now wita. It must have been a misunderstanding, they need thepatient, Mr. Epstein, to give permission for you to set up his appointment. needs to be called again and choose reimbursement services for Mr. Epstein to give you permission moving forward with his training. I will also be faxing you a form to fill out and for Mr. Epstein to sign. This gives permission to assist him. Are you free to talk to avoid misunderstandings? Thanks

KK

Hi Kristine.

-I found Erica Peltz so no worries there! :)

-I called to organize training, but they do not have him registered (which I did) and they tell me you must call them to giveme permission to schedule the appointment?! Sounds like silliness to me, but what can I do!? She let me register Jeffrey so when you call give them his Acct wand and tell them Jeffrey Epstein's personal assistant, may coordinate the training session for him. Once you do this let me know and I will call them back. Would greatly appreciate it.

Thanks,

Hello Kristine! I wanted to let you know I DID get Jeffrey's approval confirmed with and have been able to speak with a nurse on Jeffrey's behalf! A registered nurse is to call me within 1-2 business days to set up his training...truly hoping for next We, Th or Fri! I will be sure to let you know.

Some more questions:

-I understood from Dr. Shimony you will be contacting Jeffrey's insurance to find out about coverage and getting the $5 co-pay card?

-Once insurance approves the medication, when will Jeffrey receive his meds? Hoping he can get 3 months of the medication at a time...Jet me know if his insurance approves this or how many months we can receive at a time...maybe it is more!?

-will you order Jeffrey a Sharps Container? The nurse was asking me with type of injection he will be getting and I do not know...she said there are 3 different ones...

I know you are busy and will get back to me when you can!! Thank you!

Hi Kristine. Thank you for this! I actually sent jeffrey a note about this earlier but still ha e not heard back from him. He is been in constant meetings himself. I will ask him again however and use your much more well versed paragraph tomorrow morning early! Hope to have an answer soon. Thanks and have a great evening. =1

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Sorry for the late response. Just finished with patients.

-Looking a labs sent from early this month, Lipids done was calculated as opposed to direct LDL. Insurance companies look for the direct LDL when approving medications because this is a more accurate count, therefore, representing a more accurate cardiovascular risk equivalent. When the triglycerides is high, such as in the case of Mr. Epstein, the lab cannot provide an accurate LDL count. As you can see there was no LDL value given

-If you want to proceed with insurance approval, he will need to re-take labs with direct LDL. He cannot start prior to rechecking labs because it will not be an accurate reflection of his baseline without medications.

-If he wants to self pay, Century Specialty Pharmacy is willing to give him a 10% discount if he purchases ( minimum of 6 months. They will ship the medication over as soon as it's ordered and have it virtually the next day.

-Here is the breakdown of cost:

For the once a month injection $1,250/month (with 10% discount if he buys minimum of 6 months)

For the twice a month injection $1,150/month (with 10% discount if he buys minimum of 6 months)

Hope that answers all your questions. I will be available tomorrow if you have any questions. Please let me know what his decision is prescription to the pharmacy is pending his ok. Thanks

KK

Good morning. Just following up regarding Mr. Epstein's decision on how to proceed. I believe the nurse is scheduled to come in this week for teaching and ideally it would be great if she can teach and observe his first Please let me know so I can prescribe accordingly.

KK

Morning Kristine! Thank you so much for following up...I am still waiting for Jeffrey's response on all of this...Hoping to "gay but he is traveling...will let you know the minute I hear something.

Great. Just didn't want to delay the process since I know it is difficult to find time in his very busy schedule.

KK

Morning! Jeffrey has said yes to training tomorrow with Nurse Kristine. Do we know for sure if Jeffrey will be doing one dose a month or two? It should hopefully be one right? The nurse knows Jeffrey won't have the actual drug but says she can train without it. He has still yet to answer RE self pay or insurance.

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Ok sounds good