HELP!!!!!! Pertuzumab denied by insurance! iN PANIC MODE AND DON'T KNOW THAT TO DO - Page 2

KsGal · 08-30-2012, 11:35 AM

I don't have any wise advice about how to get the Perjeeta. I agree with everything Sheila said. Im just sad..sad everything has to be so difficult, sad that you have to fight so hard to get what you need to survive. I know you will get the drug, because I have seen how hard you fight, and I know you and your docs will find a way. I can give you a hug, and I can't give you any meaningful advice, but I give you my prayers and all the positive energy I can muster.

tricia keegan · 08-30-2012, 02:06 PM

Chris I have no advice sadly but I'm horrified you're being denied a drug that may help you,this would'nt happen here in Ireland and I so hope you find a way round this and will see if any of my friends in the U.S can help!

Becky · 08-30-2012, 02:31 PM

Dear Chris

It shouldn't be so hard but you are stronger. You and your oncologist need to appeal - both of you. Over and over again if necessary. I do know one thing, the greasy wheel does get the oil even though it might take awhile. Go through their process and call, call,call - everyday - all the time.

I did this for my daughter and although not life threatening, they relented and gave her treatment (took about 2 months and 2 doctor interventions) but it did work. You have a local onc too who can join the party. The insurance companies just want to know how serious you are (duh - like we aren't if we have cancer). It's alot to ask when you are having chemo (use that sweetly when talking to them - I used "my child can't breathe and I never got angry with the messenger - cry if you want but don't get angry). I know your team will secure it for you. Use every doctor you know

tricia keegan · 08-30-2012, 02:53 PM

Chrisy I have a friend working for the insurance company but not this group but she sent me this message ! work for a major health insurance...a competitor of Anthem. When you say "approved", is it on their Anthem's approved drug list, or just a legal drug? Mine was not on their approved drug list, but a couple of convincing calls later my insurer allowed it. My guess is that it was not on the approved list because it was insanely expensive."

I hope your Onc can help!about a minute ago · Unlike · 1

Andrea Barnett Budin · 08-30-2012, 02:58 PM

Yes, Chrisy, Breathe. In. Hold. Out. And again and again. Becky is wise. Never lead with anger. Befriend your person on the other end of phone.

I searched for you and came up with Perjeta Access Solutions (below). I do know that when my insur co denies me my husband gets on the phone. We've learned that sometimes, believe it or not, you have to realize you're talking to a person who is a robot or has the IQ of a penny and you just say, Thank you and hang up. Call right back and you can get a real human who becomes hell-bent on helping you.

The insur co will tell you exactly what is required for you to appeal. A letter and/or a call from your doc. Sometimes sev calls from your doc. The squeaky wheel thing is key.

Remain calm. Know that we are sending all the necessary positive energy you will need to get through this emergency. Help is on the way.

In. And hold. And out. Do not stop breathing... Keep thinking of Yosemite and your favorite spot. Go there (in your head). Recapture the feelings you had before. Bring them to you in this moment.

Much love,

PERJETA Access Solutions®

PERJETA Access Solutions helps to resolve specific access and reimbursement issues for individual patients every day. Our dedicated Specialists help bring patient treatment and practice solutions together.
Our staff can help:
Resolve benefits and coverage issues

Find co-pay assistance for underinsured patients

Provide free medicine for uninsured patients through the Genentech® Access to Care Foundation

Individualize services to meet patients' specific needs

To learn more, please contact your Genentech Clinical Oncology Specialist or call 1 (888) 249-4918 (weekdays 6AM-5PM PST), or fax 1 (888) 249-4919.
Additional resources
Get Access Solutions information

Download list of distributors

Andi

Lori R · 08-30-2012, 06:22 PM

Chris,
Another thought, just to double check. I was initially denied when I tried to see if Herceptin + Tykerb would work. I called for a couple of days and just couldn't get traction. Neither could my Dr.

I was still working (which I think you are), so I walked into HR and said I needed their help immediately to get a direct contact and help me work this through the process. It was only when my company got involved that I felt like someone even noticed my faxes. (I had images of a fax machine just feeding into a trash can).

Just a thought.....Lori

carolanno · 08-30-2012, 08:33 PM

Check your prescription drug benefits and see if you can get it directly from them and bypass your insurance.

Pray · 08-30-2012, 10:00 PM

I'm praying you get it covered soon! Gods blessings to you!

chrisy · 08-31-2012, 12:02 PM

Thanks for the support. We are nor giving up this fight, and true, we shave to be strong and put someone on my side. Sheila said it as "you have to put it on their heart". Punching them in the nose won't do that, neither will coming from weakness.

I spent all day Wednesday researching, (including Perjeta access solutions) and am continuing to gather more ammo.

We have an interim plan for. Chemo....but wait! No chemo for Christika until the horrifyingly painful infection (hopefully not a full on blood infection) inher leg is resolved. I will post this sideshow which is now on center stage on a separate thread.

Again, thanks for the love, wise suggestions and support.

Cris

phil · 09-03-2012, 09:31 AM

Someone on this board or inspire went thru abattle w/ aCalif. ins co earler this yr. her screen name was emilia i think ? It was either t dm-1 or pert that was being denied. she appealed to calif state ins board , and won. Go Public ! I feel like this is the yr for protest against all thes bureaucracies, ins co's included !

Mary Jo · 09-03-2012, 10:22 AM

So agrees with every word Sheila wrote. DAMN those insurance companies who act as if they are God and can dictate what's best for us...or not! Now, all anger aside......I also agree with what you Chrisy said ..."miracles or new medicines come from One source". God is wayyyyyyyyyy bigger than your insurance company AND wayyyyyyyyyyyy MIGHTIER! He can and WILL do it. Prayers being sent up all around the globe for you dear friend.

Mary Jo

phil · 09-03-2012, 01:16 PM

I think the woman I'm thinking of goes by " elaina ", on this board or Inspire. Perjeta is being prescribed off protocol, or thru comp use in some parts of the country . Why not in Calif. ?

Lani · 09-03-2012, 02:02 PM

Phil, if you could be more specific about where in the US perjeta is available for compassionate off-label use perhaps Chrisy could use ANGEL FLIGHT to get there.

Sheila · 09-03-2012, 05:05 PM

I believe it has more to do with insurance than where you live....I do know that out of 15 women in Chicago where I go, only myself and one other women are getting it. Theyndid say we have phenomenol insurance....so if it is denied for some, it has to be insurance....even coverage on other items is so different....my insurance covered wigs and my sisters did not....I had to,pay for Neulasta and Neupogen shots...30.00 each and she did not...we both had blue cross blue shield but different plans.
My oncologist got Very involved.I have given Chris all the info for her Dr.

phil · 09-04-2012, 08:07 AM

I also think it has to do more w/ individual docs, hospital irb's, ins. and different state regs. It has been given off protocol at farber here in Boston. caes by case basis . I have heard that in Mass. ins co' s are required to cover off protocol. Comp use was granted in Fla for darlene gant ( FB, youtube ). That was before FDA approval for first line use only. That conditional decision , and its effectrs on late stage iv pts, must be publicized. I would go to media. report the ins co to the state board . and in the media .