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Lolly · 05-10-2007, 04:10 PM

Joy, I ran into the same problem with my insurance which is a Medicare based plan. They view Tykerb as a "Specialty Drug" and it's at the highest copay. I was told I could apply for an "Exception" for Tykerb, the paperwork would take a couple of weeks, but no guarantee it would be approved.

The crime here, IMHO, is that insurance companies are allowed to classify oral chemotherapies as prescription meds and can therefore charge a higher copay, whereas infused chemo's are normally covered at 100% or close to it depending on the plan.

Seriously, there oughta-be-a-law!!! Maybe we're the ones who will have to advocate for a change!

Joy, I am shocked and dismayed for your sake. Ask about an appeal of the coverage offered, see if they can offer an exception.

And please don't give up hope.

<3 Lolly

05-10-2007, 04:10 PM	#3
Lolly Senior Member Join Date: Aug 2001 Location: Oregon Posts: 1,756	there oughta be a law Joy, I ran into the same problem with my insurance which is a Medicare based plan. They view Tykerb as a "Specialty Drug" and it's at the highest copay. I was told I could apply for an "Exception" for Tykerb, the paperwork would take a couple of weeks, but no guarantee it would be approved. The crime here, IMHO, is that insurance companies are allowed to classify oral chemotherapies as prescription meds and can therefore charge a higher copay, whereas infused chemo's are normally covered at 100% or close to it depending on the plan. Seriously, there oughta-be-a-law!!! Maybe we're the ones who will have to advocate for a change! Joy, I am shocked and dismayed for your sake. Ask about an appeal of the coverage offered, see if they can offer an exception. And please don't give up hope. <3 Lolly __________________ Sept.'99 - Dx.Stage IIIB, IDC ER/PR-, HER2+++ by IHC, confirmed '04 by FISH. Left MRM, AC x's 4, Taxol x's 4, 33 Rads, finishing Tx May 2000. Jan.'01 - local/regional recurrence, Stage IV. Herceptin/Navelbine weekly till NED August 2001, then maintenance Herceptin. Right Mast. April 2002. Local/Regional recurrence April '04, Herceptin plus/minus chemo until May '07. Gemzar added from Feb.'07-April '07; Tykerb/Abraxane until August '07, back on Herceptin plus Taxotere and Xeloda Sept. '07. Stopped T/X Nov. '07, stopped Herceptin Dec. '07, started Avastin/Taxol/Carboplatin Dec. '07. Progression in chest skin, stopped TAC March '03, started radiation. Herceptin has served as the "Backbone" of my treatment strategy for over 6 years, giving me great quality of life. In 2005, I was privileged to participate in the University of Washington/Seattle HER2 Vaccine Trial.