Zometa infusions denied by ins.: To skip it or to pay?

[Vic]

My onc. discussed Dr. Michael Gnant's Australian study on zoledronic acid (zometa) and the benefits that came out of the study showing reduced events in bone mestatases when he spoke at ASCO.

My insurance will not pay it and at $2K ea. (just guessing here), it would be quite expensive. I know some of you get it for having osteopenia and osteoporosis, but my insurance company doesn't.

Then, this week there was an article in the "Los Angeles Times" that "Cancer risk is reported for bone drugs" with the subtitle: "A few dozen patients who take Fasamax, Actonel or Boniva have developed esophageal disease, an FDA official says."

I don't know if Zometa falls into this same bisphphonate category, but with everything there are pros and cons. I don't think I want to pay out-of-pocket as much as $12,000, especially with new warnings coming to light.

Any advice on this or can you share your current thinking on this topic?

Thanks,

Vicki

[Bill]

Hi Vicki! You got some good questions there. I'm sure you'll get some good responses to help with your decision. For what it's worth, Nicola received a Zometa infusion once a month when she was on chemo., sorry I can't remember the amount, but I have read here of many women receiving Zometa every 3 months or every 6 months, I think. Maybe one option would be to sit back and keep researching, like you are now, and possibly pay out-of-pocket once or twice a year. In my way of thinking, that way you would still receive the proven benefits of Zometa, and at the same time, more data/research info. would become available to you over that period. And who knows, possibly your insurance situation could change also during that time. Is it a 12k deal or nothing? I'm not an expert on meds. or money, mind you, just offering my thoughts. Good luck to you.

[sassy]

Hey Vicki,

I receive Zometa once a year at this point for bone building and prevention. My insurance would not pay until we proved bone loss. We did this by having a base line bone density test, then a second test about a year later which showed loss. Have you checked with your insurance to see if they would pay under these circumstances?

As far as esophageal disease, I doubt that it would be an issue with Zometa, as it is administered by infusion rather than orally as the other bisphphonates are.

I hope you can work something out.

[Gerri]

Hi Vicki,

"A few dozen patients" out of how many? Were there other risk factors for esophageal disease in these patients? As we all know, there are risks with every treatment; we just have to weigh the benefits against the possible risks and make a decision on how to proceed.

I have had one infusion of Zometa (last August) due to a bone density test showing osteopenia; my insurance (POS/PPO) paid for it. I just saw a new onc today and he was happy to have me continue with Zometa every 6 months for a total of three years. (I will receive my second dose in Feb.) He said the newest research is showing Zometa not only prevents bone mets in bc patients, but other mets as well. For now I am opting to continue, I just hope my insurance continues to pay for it.

Best of luck to you.

[Henny]

Vicki,
I had my first zometa infusion in October. My onc was going to charge about $1400 if my insurance didn't cover it. The insurance surprisingly did pay. I thought it would be worth it since it has shown to decrease recurrence by 30% in the first studies (according to my onc).
Today I had a bone density study. It showed that my osteopenia had improved since my last test last year -possibly due to the zometa. I didn't expect a positive side of it so soon.
I know it's really hard to roll the dice and decide what is worth the expense, se's, pain etc but my philosophy is to do whatever I can up front and hopefully not have to chase this thing from behind.
Seems like there's always something to wrestle with.
Best to you
Henny

[Vic]

Hi Bill, Sassy, Gerri and Henny,

You made my morning! I just emailed the nurse and my onc. involved in setting up the Zometa injections and have decided to have them even if the insurance co. doesn't pay. I did let them know that many of you have yours paid for by insurance due to the osteopenia/osteoporosis shown on your bone density scans. So, I suggested one as a baseline before I start the Zometa.

Thank you for your very wise advice. You each make things so clear in the decision-making process, that it really helps me to processs these issues. That means so much to me that I could come here first thing in the a.m. and hear your reasoned responses. My husband said that money is not a factor and that I should do it anyway, even if insurance doesn't pay. You can't put a price on your health.

Have a terrific day and thanks again.

XO,

Vicki Z

[Debbie L.]

Hi Vickie,

1. I'm pretty sure the esophageal issues are with oral administration. That does still leave the issues of heart arrhythmias and osteonecrosis of the jaw. However they are rare side effects.

2. Insurance denial is always worth appealing.

3. The studies that are reporting so far (Gnant's for example) are showing decrease in all mets, not just bone. One caveat about his study is that it included only hormone (ERPR) positive cancers, which do tend to be more likely to develop bone mets. So are the results relevant to ERPR negative cancer? Is there something about ERPR+ cancer's interaction with bone that explains why Zometa seemed to prevent all mets and if so, will that result be limited to the ERPR+?. We don't know for sure.

4. You're almost 4 years past treatment, right? There's no information at all about that circumstance.

No answers. But if you do want it, I'd suggest the first step would be to appeal denial. What's your bone density?

Debbie Laxague