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Heide · 08-25-2007, 05:10 PM

Hello Everyone,

I started on Tykerb/Xeloda on 8/22/07. It was over 26 days from when my Onc prescribed it until I rec'd scripts in the mail. He said that was a long time to wait and to receive it. I had road blocks with my prescription coverage, as I'm sure others have. I have Anthem bc/bs that I buy myself (not thru an employer) because my husband is self-employed and I work at part-time and don't receive ins. benefits. Anthem has been wonderful to me! Unfortunately though, my prescription benefit has a max of $2000 per year; and since Tykerb/Xeloda fall under prescriptions; I couldn't get a month supply of either drugs. After buying a 25 day supply (5 pills a day) of Tykerb, I maxed out my coverage and put the $497 dollar remainder on my credit card. I then was considered prescription un-insured and applied to Roche (with the help of my Onc and his fabulous nurse) and Roche is providing me with a 3 month supply of Xeloda while they assist me in finding alternative funding. The Tykerb is hopefully coming from another program called Committment to Access. I'm still waiting to here from them about my app.

I guess my reason for telling you all this is because I feel like, well, for lack of a better word, a loser because I can't pay for my own medicine. But who can afford $4000-$6000 a month for prescriptions! Lots of insurances must have caps on prescription benefits right? I don't know how long I'll be on this treatment, and with new drugs coming out in the future, I'm sure they'll be scripts (pills) as well. Because there was a lag between xments (I was taken off HKI-272 phase 2 trial in July), my Onc had me come in for a dose of Herceptin to hold me over. It makes no sense to me that my ins. will pay for the Herceptin infusion, but not Tykerb/Xeloda pills. If I could get Tykerb/Xeloda in infusions I would, but was told it doesn't come that way.

My husband tries to comfort me and tell me that I will get my medicine and not to worry, but I get real upset about it. I know I shouldn't put a price tag on my health (and ultimately my life) but it's hard not to. Has anyone else out there felt this way or had these problems?

Thanks for listening.

08-25-2007, 05:10 PM	#4
Heide Member Join Date: Jul 2007 Location: New Hampshire Posts: 11	Problems with script coverage for Tykerb/Xeloda Hello Everyone, I started on Tykerb/Xeloda on 8/22/07. It was over 26 days from when my Onc prescribed it until I rec'd scripts in the mail. He said that was a long time to wait and to receive it. I had road blocks with my prescription coverage, as I'm sure others have. I have Anthem bc/bs that I buy myself (not thru an employer) because my husband is self-employed and I work at part-time and don't receive ins. benefits. Anthem has been wonderful to me! Unfortunately though, my prescription benefit has a max of $2000 per year; and since Tykerb/Xeloda fall under prescriptions; I couldn't get a month supply of either drugs. After buying a 25 day supply (5 pills a day) of Tykerb, I maxed out my coverage and put the $497 dollar remainder on my credit card. I then was considered prescription un-insured and applied to Roche (with the help of my Onc and his fabulous nurse) and Roche is providing me with a 3 month supply of Xeloda while they assist me in finding alternative funding. The Tykerb is hopefully coming from another program called Committment to Access. I'm still waiting to here from them about my app. I guess my reason for telling you all this is because I feel like, well, for lack of a better word, a loser because I can't pay for my own medicine. But who can afford $4000-$6000 a month for prescriptions! Lots of insurances must have caps on prescription benefits right? I don't know how long I'll be on this treatment, and with new drugs coming out in the future, I'm sure they'll be scripts (pills) as well. Because there was a lag between xments (I was taken off HKI-272 phase 2 trial in July), my Onc had me come in for a dose of Herceptin to hold me over. It makes no sense to me that my ins. will pay for the Herceptin infusion, but not Tykerb/Xeloda pills. If I could get Tykerb/Xeloda in infusions I would, but was told it doesn't come that way. My husband tries to comfort me and tell me that I will get my medicine and not to worry, but I get real upset about it. I know I shouldn't put a price tag on my health (and ultimately my life) but it's hard not to. Has anyone else out there felt this way or had these problems? Thanks for listening. __________________ DX at age 37 on 5/24/05 Left breast IDC and DCIS, high-grade modified radical skin-sparing mastectomy 7/11/05 with re-con TRAM flap. tumor size 3.5 cm HER2 To CEP-17 Ratio = 6.76 positive ER positive A & C infusions Aug. - Oct. 2005 Taxol & Herceptin infusions Oct. - Dec. 2005 6 weeks radiation completed March 2006 Continued on Herceptin every 3 weeks until 10/24/06 re-occurence left side supraclavicular nodes Jan. 2007 HKI-272 phase 2 Trial Jan. - July 2007 (supra nodes shrunk for awhile) Enlarged node in chest wall near windpipe. started Tykerb/Xeloda 8/22/07 (on for 2 months - not working - 3 new liver mets). 11/07 Neupogen(G-CSF)/Herceptin/Navelbine Trial 11/07 2/8/08 Catscan shows 1 of 3 liver mets went from 9 to 24mm. 2/29/08 Phase II trial of Ertumaxomab. 4/10/08 Catscan shows progression on liver mets and 2 new liver mets. 4/11/08 Started Taxotere/Herceptin.