Insurance Company Does Not Want to approve TYKERB - Page 4

hutchibk · 10-20-2009, 09:56 PM

haha Dana. Great idea.

Pam P · 10-21-2009, 03:13 AM

Sheila - I admire your fight with this issue - as someone suggested if we bombard someone with letters of protest let us know. I also like the idea of contacting the media & getting your dilemna public attention as a great example of how the insurance company dictates our treatment not our doctor's best recommendations. I really really admire your sense of humor as well as your perseverence. I'm in your cheerleading section. Pam

Sheila · 10-21-2009, 04:57 AM

Dana, thank you for the offer...I may need it. Last night after getting a no from my husbands company, I decided to write my own appeal to the insurance and Caremark/CVC. I faxed 14 pages, much of the info I got from all of you in this post...I know it will probably do no good, but I felt by doing this, I was getting the last word with them....I will start calling as soon as they open this morning.....I am hoping they will be so sick of me they will give me the damn Tykerb to shut me up!

Mary Anne in TX · 10-21-2009, 06:59 AM

I love the plan of action!
Still believin' ma

TSund · 10-21-2009, 10:39 AM

My letter will be up front.

AND I will write to them that I am sending my letter to every major newspaper in the country. We should all do likewise. Maybe a threat of bad publicity will get them moving.

What WILL they approve at this point? Are they admitting to approving nothing at all?

(I guess they still pay for Herceptin at this point?)

10-21-2009, 11:14 AM

If someone will E-mail me the address of the insurance company Ill write them too. I am a pharmacist in his sixties who can remember the pre-insurance, third party days when people paid for their meds like you buy food. the prices of the drugs were 1-2% of what they cost today. Tykerb might cost a faily 200 dollars for a months supply not 7000. What family could afford 7000-8000 a month for one drug? I smile when I work at Rite aide and somebody pais a 45 dollar copay for a drug only partly covered by insurance. Invariably they will ask something like "What would it cost me without insurance?" The answer: 275 dollars. The response : WHEEEEEEEW Thank GOD I have insurance. What the people dont realize is that the copay they are paying is twice as much as they would have paid in the cash days of 20plus years ago. If you want me to write send me the address of the Insurance company. My e-mail address is Donocco5w4@AOL.com

Paul

whatz · 10-21-2009, 11:58 AM

Ditto for me (though I do not have the pharmaceutical background :-) ). My email is gdc_j@megagate.com Strength in numbers. Maybe we can even come up with a format of a letter to write so we all can flood the insurance company. Take advantage of this internet and get it posted beyond the borders of this site.

DanaRT · 10-21-2009, 12:12 PM

my email is timmfam@ligtel.com

I have no problem making my voices heard. I just want to have the facts straight before I write a letter.

StephN · 10-21-2009, 12:15 PM

Dear Sheila -
We will ALL be glad to help you keep that wheel squeaking good and loud.

Remember how the 'activists' handcuffed themselves to their steering wheels and blew the horns in front of Genentech to protest not getting Herceptin for compassionate use?

Dressed in our fishnet stockings, short skirts and red heels ...

michka · 10-21-2009, 12:51 PM

Sheila, ready to join the fight WHERE SHOULD WE WRITE? Michka

TSund · 10-21-2009, 10:49 PM

hmmm...when our cabin was flooded by a broken pipe fixture (during Ruth's chemo to boot) and insurance was really balking I finally wrote to the state insurance board. That got Travelers moving in a hurry. It was a good "learning" for me as they had me believing their claims that they were not resonsible for x , y and z. (they were) I called the TX State Insurance Board as a last resort. Traveler's did an abrupt about face, and it was clear that they were just out to try to fleece us if they could.

Is there something like this for health insurance?? (maybe even the same entity?)

Karen Wheel · 10-22-2009, 09:49 AM

Sheila - hang in there - wow - sounds like a bunch of stupid people at the insurance company!
I have to thank god, again, that I live in Italy with free health care and my oncologist dictates what I get --- very cool!

Hang in there - something will give-
Joe's on it now!

;-)
Karen

Jackie07 · 10-22-2009, 10:49 AM

Sheila,

Just wanted to lend you some 'moral support'. I recalled the story my Mother had told us many times. It was during my Oldest Sister's hospitalization. She (14 years my senior) was having pneumonia and needed an antibiotic shot that was very expensive at the time because it was a new, imported drug. The hospital staff told my Mother that the shot would not be administered until our family paid a 'garrantor' downpayment on the drug. My Mother, a small town mayor, 'pounded' on the desk in the office and 'told' them to give my Sister the 'shot' - "Right now!"

Oldest Sis got the needed medicine and recovered soon. Whenever I was in a similar situation, I thought about my Mother and held my ground [very much against my personality as I am the 'baby' in the family. Just did it with my family doctor on demanding an MRI. Now he's giving me a referral to the neurologist after getting the MRI report.]

Karen Wheel · 10-22-2009, 11:09 AM

Great news with support from the group! WOW! Very cool! And, Jackie - love the pounding the fist --- I think I'll try that too - I want an MRI to baseline to make sure there is nothing going on (bad) in my head! :-) HEE HEE. I'm the baby too - and forceful -but hate having to get the fist out.

Great advise all!
K

Carolyns · 10-23-2009, 11:00 AM

Hi Sheila,

I hope that you are getting somewhere with this fight.

Please forgive me if you have already gone into this but can you please explain why they can prevent your doctor from prescribing Tykerb alone?

You said, "OK, today is day 9 since Tykerb was ordered, the insurance company, BCBSIL and CVS/Caremark is not wanting to approve because it was not ordered with Xeloda.....

I know this is happening all over the place (because it happened to a friend of mine) but what is the justification for saying no if Medicare approves? Is it because it is an oral drug. My heart breaks for you in this fight (it is SO WRONG) and I am not sure if others realize what a big problem this is becoming for us. Understanding more may help us be better advocates.

Love, Hope, Peace, Carolyn

hutchibk · 10-23-2009, 12:37 PM

Apparently rules is rules... so the key is really listening to what they say they need in order to fill it. If they require it with Xeloda, then get it written with Xeloda, and don't take the Xeloda. Sounds wasteful, but these kinds of stories of waste and inefficiency happen all over the spectrum. Better than being in the UK though, where NICE just turned down access to Tykerb again this week... sad.

IRENE FROM TAMPA · 10-23-2009, 02:52 PM

Hi Sheila

I am so sorry for what you are having to go through with all of this. --

I am a little confused as to the refusal.

Do you have Blue Cross Blue Shield as your insurance?

I also have Blue Cross (blue options plan) with my company. My onc called RX -to - Go and placed the order, they inturn ok'd if covered by Blue Cross who said yes and I received immediately. I don't really think that the onc or the pharmacy has the call to refuse- it has to be the insurance company. I do not understand how the Pharmacy co. can refuse if your insurance approves.

I know this all can be so fustrating, but just wanted to clarify that point for myself since I am so frustrated for you.

Good luck my friend

TSund · 10-23-2009, 03:47 PM

I think Sheila said in an earlier message that now they will not approve the Xeloda/Tykerb combo due to the fact that the doctor stated that Xeloda in the appeals for Tykerb/Herceptin had failed for Sheila. And they did not and still do not approve Tykerb by itself, perhaps because the studies were done in combination with Xeloda?

@#$%^&* greedy, uncaring, insensitive asses looking for any excuse to say no imho.

TRS

Chelee · 10-23-2009, 04:16 PM

All I know is this is a bunch of bull sh$% & it really ticks me off. Like we don't go thru enough fighting this misrable disease. Shelia...if there is ANYTHING we here as a group can do for you just let us know. I am sure everyone would be more then happy to help in anyway possible. Write letters, make calls...you name it! Every minute of every day for you should not be eaten up trying to get the insurance company to ok Tykerb. This is beyond ridiculous which I don't have to tell you. It makes me so angry that you have to deal with this.

Have you heard back from them since you last FAXED them the 14 pages you sent? I hope something positive has happened by now? If not...I'm serious...lets figure this out and get you that Tykerb...there has got to be a way!

Chelee

hutchibk · 10-24-2009, 01:14 AM

I think the denials from CVS/Caremark said that they can only fill it if written with Xeloda regardless what the doctor described about her history with Xeloda... which means that they don't really care that you have had previous failure with Xeloda, that is what you need to do for them to fill it. They gave the answer, it's just a matter of latching on to it and doing it their way, even if it is a stupid way.

Luckily in her most recent post, she has gotten spectacular results by sticking to her guns and writing her own appeal, so hallelujah!