Herceptin/Halaven
 

Im looking for some input into the combination of Halaven and Herceptin. My wife has been prescribed this combination but my insurance says the combination hasnt been recognized by the FDA. They say they will pay towards the Halaven if she discontinues the Herceptin. Ive posted an update in the newcomers forum of this site and have had a few responses that lead me to believe there are some out there that are successfully receiving this combination through their insurance. I would like to hear from some more of these people, Is my insurance lying to us? If this hasnt been approved or recognized how can some insurances pay and others wont?

Re: Herceptin/Halaven
 

As I mentioned before in your earlier post several of our members were successfully treated for skin mets with Herceptin and Halaven.
Now Excuse me, but how dare your insurance company dictate what treatment a person can receive !!
Your wife's doctor can decide to prescribe something "off label" which means prescribing something a bit different than FDA recommendations. Doctors sometimes do that when they believe the slightly different combination will work better than what the FDA recommends. Doctors usually make those decisions based upon previous experience with other patients and their current patient's condition.
As long as your wife's doctor fills out the insurance paperwork for the Halaven correctly he or she does not have to even mention the Herceptin on that paperwork. The insurance company does not even have to know about the Herceptin.
I suggest you call Genetech at 1-800-821-8590 on Monday and ask how your wife can apply for financial help for the Herceptin. The above phone number might not be the correct department at Genetech, but you can ask the person who answers to transfer you to the correct department. Genetech phone numbers will also be listed on the Herceptin and Genetech websites. You might want to check that out over the weekend. There is an application process and It might take awhile to get it, but at least you can get the ball rolling right away. There are also other assistance programs. I suggest you call your local American Cancer Society office and ask how to go about applying for some of them. The doctor's office might have patient resource books in the waiting room or in the chemo room. One is published by Cure magazine and the other is published by Patient Resource group. There are usually lists of places you and your wife can apply for various kinds of financial assistance for drugs listed near the back of those guides.
Then your wife might want to ask her doctor to prescribe the Halaven immediately and add the Herceptin as soon as you can figure out the financial part.
If all else fails go to clinicaltrials.gov and see if there is a clinical trial for Herceptin and Halaven your wife can apply for. Your wife's doctor might be interested in helping her get into that if it is available. All drug expenses might be paid if going that route is an option. The Genetech trial line is 1-800-662-6728.
Doing something is usually better than waiting for insurance companies and doing nothing while waiting.

Re: Herceptin/Halaven
 

We had just applied for Herceptin co-pay assistance the first of the month. The makers of Halaven told us if I have insurance that will pay for their drug I wont qualify for their assistance. What Im looking for is examples of women that are successfully getting Herceptin/Halaven through their insurance.

Re: Herceptin/Halaven
 

Sheila got this combo paid by her insurance. Have you/your doctor file an appeal - let them know you are not giving up without a fight.

Re: Herceptin/Halaven
 

Hmmm..
I wasn't aware the FDA was in the business of approving combinations..just the drugs alone.

Re: Herceptin/Halaven
 

You might want to re connect with Genetech and see what they would suggest about your circumstances.
You might also want to contact the drug company that makes Halaven and see if they have some kind of financial assistance program.
I also agree about making an appeal. Go the normal route, but also try to find a higher level person at the insurance company to contact about this problem.
Your insurance company has no business dictating the treatment your wife must or must not receive. The insurance company does not know your wife's completel medical history and current situation.
Whether or not somethings gets approved may depend on how a doctor writes up an authorization form for the insurance company. Perhaps your wife's doctor would be willing to make a stronger case by wording the request differently. Maybe how your doctor plans the treatment might make a difference too. Maybe doing the Halaven weekly and doing the Herceptin every 21 or or every 28 days when your wife can take a Halaven break might help get the insurance to pay for it.
Maybe Sheila has some suggestions about getting insurance to pay for it. I think she took Herceptin and Halaven successfully for skin mets.
Good luck. Take care.

Re: Herceptin/Halaven
 

The FDA might have some power when it comes to drug combinations, but I don't think the insurance company should have that kind of power over people.

Re: Herceptin/Halaven
 

Hi~
Sorry you're having to deal with this added frustration!
I received Halaven+Hercepting x two cycles of 9, so ~18 weeks before I had to switch treatments.
I didn't have any troubles with my insurance company.
I would imagine that your 1st step would be a Letter of Medical Necessity from the onc to appeal the insurance co's decision.
Good luck & Keep the faith~
Jml

Re: Herceptin/Halaven
 

My insurance didn't even question the combo, and I was the first person in the Midwest to receive it. I had an amazing response for my skin mets....the girls saw it first hand in San Antonio....wish it would have kept working....but you can see from my signature that it worked for some time....if I can help in any way, let me know....Like I said, I had Blue Cross Blue Shield insurance