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01-29-2012, 09:46 AM
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#1
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Senior Member
Join Date: Sep 2010
Location: Shelby, N.C.
Posts: 114
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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?
__________________
Diag. Aug. 2010
ER- PR- Her-2 +++ Stage IV
Mets to T 6th Vertabrae
Radiation to spine
10/23/10StartNavelbine
11/19/10 Port installed
11/22/10 Started 2nd cycle
1/10/11 Finished 2nd cycle
1/24/11 Herceptin Only
3/7/11 progression, start Taxol/Herceptin
4/18/11 Skin mets appear increase treatments to weekly
rash spreads to right breast
7/5/11 enroll in TDM-1 study
7/29/11 randomly assigned Tykerb drop out of trial and start Tykerb /Herceptin no Xeloda skin mets gone Tykerb working
1/31/12 Skin mets return add Xeloda
5/9/12 Stop Tykerb skin mets back
5/17/12 Return to Navelbine/Herceptin
6/26/12 start process for TDM-1 compassionate access
8/28/12 Start TDM-1
10/9/12 third TDM-1 no response yet
10/23/12 Start Haloven
1/17/12 Start Perjeta/ Herceptin/Taxotere
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01-29-2012, 11:18 AM
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#2
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Senior Member
Join Date: May 2006
Posts: 3,142
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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.
Last edited by ElaineM; 01-29-2012 at 11:27 AM..
Reason: correction, additions
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01-29-2012, 12:39 PM
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#3
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Senior Member
Join Date: Sep 2010
Location: Shelby, N.C.
Posts: 114
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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.
__________________
Diag. Aug. 2010
ER- PR- Her-2 +++ Stage IV
Mets to T 6th Vertabrae
Radiation to spine
10/23/10StartNavelbine
11/19/10 Port installed
11/22/10 Started 2nd cycle
1/10/11 Finished 2nd cycle
1/24/11 Herceptin Only
3/7/11 progression, start Taxol/Herceptin
4/18/11 Skin mets appear increase treatments to weekly
rash spreads to right breast
7/5/11 enroll in TDM-1 study
7/29/11 randomly assigned Tykerb drop out of trial and start Tykerb /Herceptin no Xeloda skin mets gone Tykerb working
1/31/12 Skin mets return add Xeloda
5/9/12 Stop Tykerb skin mets back
5/17/12 Return to Navelbine/Herceptin
6/26/12 start process for TDM-1 compassionate access
8/28/12 Start TDM-1
10/9/12 third TDM-1 no response yet
10/23/12 Start Haloven
1/17/12 Start Perjeta/ Herceptin/Taxotere
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01-29-2012, 01:03 PM
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#4
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Senior Member
Join Date: Sep 2005
Location: Central Coast, CA
Posts: 3,207
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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.
__________________
Chris in Scotts Valley
June 2002 extensive hi grade DCIS (pre-cancer-stage 0, clean sentinal node) Mastectomy/implant - no chemo, rads. "cured?"
9/2004 Diag: Stage IV extensive liver mets (!) ER/PR- Her2+++
10/04-3/05 Weekly Taxol/Carboplatin/Herceptin , complete response!
04/05 - 4/07 Herception every 3 wks, Continue NED
04/07 - recurrence to liver - 2 spots, starting tykerb/avastin trial
06/07 8/07 10/07 Scans show stable, continue on Tykerb/Avastin
01/08 Progression in liver
02/08 Begin (TDM1) trial
08/08 NED! It's Working! Continue on TDM1
02/09 Continue NED
02/10 Continue NED. 5/10 9/10 Scans NED 10/10 Scans NED
12/10 Scans not clear....4/11 Scans suggest progression 6/11 progression confirmed in liver
07/11 - 11/11 Herceptin/Xeloda -not working:(
12/11 Begin MM302 Phase I trial - bust:(
03/12 3rd times the charm? AKT trial
5/12 Scan shows reduction! 7/12 More reduction!!!!
8/12 Whoops...progression...trying for Perjeta/Herceptin (plus some more nasty chemo!)
9/12 Start Perjeta/Herceptin, chemo on hold due to infection/wound in leg, added on cycle 2 &3
11/12 Poops! progression in liver, Stop Perjeta/Taxo/Herc
11/12 Navelbine/Herce[ptin - try for a 3 cycles, no go.
2/13 Gemzar/Carbo/Herceptin - no go.
3/13 TACE procedure
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01-29-2012, 01:25 PM
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#5
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Senior Member
Join Date: Feb 2008
Location: South East Wisconsin
Posts: 3,431
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Re: Herceptin/Halaven
Hmmm..
I wasn't aware the FDA was in the business of approving combinations..just the drugs alone.
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01-29-2012, 03:15 PM
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#6
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Senior Member
Join Date: May 2006
Posts: 3,142
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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.
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01-29-2012, 03:18 PM
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#7
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Senior Member
Join Date: May 2006
Posts: 3,142
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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.
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01-29-2012, 03:36 PM
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#8
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Senior Member
Join Date: Dec 2006
Posts: 415
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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
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01-29-2012, 03:47 PM
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#9
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Senior Member
Join Date: Aug 2003
Location: Morris, IL
Posts: 3,507
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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
__________________
"Be kinder than necessary, for everyone you meet is fighting some kind of battle."
Hugs & Blessings
Sheila
Diagnosed at age 49.99999 2/21/2002 via Mammography (Calcifications)
Core Biopsy 2/22/02
L. Mastectomy 2/25/2002
Stage 1, 0.7cm IDC, Node Neg from 19 nodes Her2+++ ER PR Neg
6/2003 Reconstruction W/ Tissue Expander, Silicone Implant
9/2003 Stage IV with Mets to Supraclavicular nodes
9/2003 Began Herceptin every 3 weeks
3/2006 Xeloda 2500mg/Herceptin for recurrence to neck nodes
3/2007 Added back the Xeloda with Herceptin for continued mets to nodes
5/2007 Taken Off Xeloda, no longer working
6/14/07 Taxol/Herceptin/Avastin
3/26 - 5/28/08 Taxol Holiday Whopeeeeeeeee
5/29 2008 Back on Taxol w Herceptin q 2 weeks
4/2009 Progression on Taxol & Paralyzed L Vocal Cord from Nodes Pressing on Nerve
5/2009 Begin Rx with Navelbine/Herceptin
11/09 Progression on Navelbine
Fought for and started Tykerb/Herceptin...nodes are melting!!!!!
2/2010 Back to Avastin/Herceptin
5/2010 Switched to Metronomic Chemo with Herceptin...Cytoxan and Methotrexate
Pericardial Window Surgery to Drain Pericardial Effusion
7/2010 Back to walking a mile a day...YEAH!!!!
9/2010 Nodes are back with a vengence in neck
Qualified for TDM-1 EAP
10/6/10 Begin my miracle drug, TDM-1
Mixed response, shrinking internal nodes, progression skin mets after 3 treatments
12/6/10 Started Halaven (Eribulen) /Herceptin excellent results in 2 treatments
2/2011 I CELEBRATE my 9 YEAR MARK!!!!!!!!!!!!!
7/5/11 begin Gemzar /Herceptin for node progression
2/8/2012 Gemzar stopped, Continue Herceptin
2/20/2012 Begin Tomo Radiation to Neck Nodes
2/21/2012 I CELEBRATE 10 YEARS
5/12/2012 BeganTaxotere/ Herceptin is my next miracle for new node progression
6/28/12 Stopped Taxotere due to pregression, Started Perjeta/Herceptin
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