Hi Poseymint! Thank you for your excellent response!
I wonder if it might be better if you get your Nplate injections in a doctor's office.? I know thats the way it has worked for me. Is that an option? I didn't think it was approved to do home injections in the US. I have United Healthcare Medicare (which is different than your college insurance) and my Nplate Is paid for, but only because it is done at the cancer clinic. That would be billed under the "medical benefits". Mine is not covered under the pharmacy benefits as you mentioned. But yours might be different- your hematologist office would know.
That was an option though, but during my first visit to the doctor, he said there was another student which is receiving it at home, although his provider was not my doctor and he had only heard of him at their hospital. During the month they were asking for pre-auth (which was never required), the doctor also wrote a letter to insurance stating that I have been self-injecting for 3 years and he believed I should do since coming into the office every week is a huge burden on me and the hospital. They definitely have sent that letter to the insurance since I got a copy of it, but I don't know if they have taken this into account or not. And yes, initially when I emailed and inquired about UnitelHealthcare from J2796, they told me this is approved for administration in the office. Since as you know, for every shipment optum calls medical benefits, I have a strong feeling that this is gonna be ok since otherwise, UHC would not give ok to send thousands of dollars worth of medicine to a student

. The hospital nurse (after talking with optum and UHC) also told me it was ok to have it at home and she documented these on my chart which she told would be a legal document. And finally, what also made me confident was this:
Although not commonly self-administered at home in the United States, most of our patients can administer romiplostim at home after discussion with their insurer and training the patient. Home administration has been shown to be as effective as that by a healthcare provider , aob.amegroups.com/article/view/6335/html
I now believe chances are low that I get denied only because I administered at home, after all these conversations. I hope so!
I can't really answer your question about United Healthcare statement and what they mean by $0 paid. I think it means that you owe nothing? On my bills it says "amount paid to you" which is always $0. (because the money is going to the provider, not me). Not sure if thats what you are seeing on your bill. When I had Amgen First Step, Amgen paid my high deductible/max out of pocket which was $6000-7000 per year. I ran up that much in the first month because I need two vials per week. It was my max out of pocket, so after that was sorted out, I paid nothing for medical the rest of the year. But getting it sorted out was very stressful every year.
I also get two vials per week. Now that I checked the initial hospital bill (which was processed) more deeply, it seems the paid amount on the website bill is the amount that the insurance has paid, so we have paid = total benefits. In the case of hospital visit, the bill was $300 and the paid amount was like $100 and the rest, 300 - 100 = 200 was considered patient balance, which I had to pay out of my pocket, and that $200 was deducted from $1800 maximum out of pocket so now it is $1600.
What I just wanted to ensure is that as you said, what Amgen's first step is going to pay (on the very first bill, which would be more than my left balance of $1600) would now zero out my maximum of-pocket for the rest of the year, as you said. What I expect and want to ensure will happen is what Amgen is going to pay would zero out my out-of-pocket balance and I do not need to pay anything, rather than not decreasing my out-of-pocket balance so that I will have to pay the remaining $1600 out of my pocket, soon where the Amgen's $10000 annual limit was hit. I attached the bill maybe it helps to get the clarification.
drive.google.com/file/d/1PlZ-eKygqkHlm4jUSEXj_k4S1sN9Xvg4/view
And finally, yes. unfortunately, you will become an insurance expert going through all this

I hope it processes smoothly and my future work insurance is much better than this!
Thanks for your kind answer