Cmemotherapy drugs not covered by insurance query

[evlin75]

Daughter Susan in Florida is working on legislation regarding insurace companies paying for oral chemotherapy drugs prescribed by their physician. There will be an effort to expand it federally also.

If you have had past problems getting them covered or are having current problems -and are willing to go public - she would like to talk to you.

She has gone public so many times now that she is used to the publicity, but realizes others might not want to go public with their personal story. She needs a "face" or two to the story besides her own.

If anyone is interested, feel free to email me at carev@embarqmail.com and I will send it on to her, so she can contact you.

Thanks for your time and my best regards to you all,

Ev from ohio -mom of Susan in Florida

[hutchibk]

Please clarify... covered under what part of Insurance? I believe that some cover orals under prescription coverage, but within $$ cap limits. Is she lobbying to have them covered under medical coverage instead, as infused chemo is covered? Until Medicare changes their coverage of orals and makes them medical instead of prescription, you might not see too much action.

Everything private insurance related follows Medicare denials, actions and guidelines... so it would make sense to start at that federal level to make changes, and then work your way down to private carriers.

[evlin75]

Brenda,
I hope this does not post twice as I replied once to this but it vanished.
They are trying to get parity brtween intravenous chemotherapy and oral chemotherapy. If it is chemotherapy it should be covered the very same way.
Federal legislation lying in congress without action is causing the states to try to bring attention to the problem. Sometimes it takes a bit of publicity and attention to get change.
According to my daughter Medicare has not been entirely consistant in the way they are treating this either.

Thanks,
Ev

[evlin75]

Sorry about the mis-spelling in the title. I will try to spell check more closely before I post again. I could not figure out a way to fix it after it posted. I have mostly read here and have posted infrequently since my daughter's diagnoses in 2003.

Ev

[Sheila]

I had quite a problem trying to get my insurance to cover Tylerb....they didnt want to cover it the way the Dr ordered it...and all the while I waited, my mets were enlarging...wondering why I see an oncologist if the insurance company makes the decisions on my treatment! Not many could afford to pay for these drugs out of pocket! i finally got it covered, but it took 3 appeals, lots of stress, and 3 months!