Question on Drug Replacement!

[Mary Anne in TX]

I finally got one of those letters from my insurance company that said "no more herceptin paid for, now stop asking. This is final." So the insurance company is done with me on this! They've been good til now and I appreciate that.
My doctor's office had me fill out the drug replacement application so that they could submit it. If I happen to get approved, how do I cover all the other cost involved with the infusion. I don't have a clue how all that works. Do I cover those costs?
I've been really fortunate to have had over 2 years of herceptin and I'm grateful. Just trying to get my mind set for what is next and how to handle it.
Thanks for your input and have a great 4th of July weekend. I'll put on a pot of beans and sausage and gather with some neighbors for a cookout. Nothing quite as wonderful as people, ice tea and barbeque! Love to all, ma

[Becky]

Dear Mary Anne

Alot of times an insurance company won't cover the cost of the drug but will cover everything else so MAKE the cancer center itemize everything. They will cover the doctor visit and the other things (infusion "gear" like needles, bag, iv time, nurse etc) - just not the bloody drug!

[ElaineM]

Some drug companies have scholarship programs for patients who have insurance issues or financial problems. Maybe you can check to see if the drug company that makes Herceptin has one of those.
Check the link for Resource on the front page of this website. There are links to resources for financial issues. You might find something there to help you with your situation.

[Mary Anne in TX]

Elaine thanks for the links and Becky your information was so encouraging. I'll keep fighting! ma

[Lani]

are you Stage IV and NED? If so I can try to send you links to articles that recommend continuing herceptin (and just add drugs to it if/when resistance develops) in Stage IV patients. If you are not, and have just continued adjuvant therapy longer than the recommended one year, I fear the story will be "There is no evidence for randomized clinical trials" (something heard over and over again)

If you look at your insurance policy they often use wording as to what they consider experimental treatment. Showing that wording to your doctor might help him/her phrase a letter in a way to force them to reconsider.

Best of luck!

[Mary Anne in TX]

My onc called them and they approved continued use and then they sent me (and him) the letter telling me it was experimental and they would not reconsider paying for the treatment under any circumstances. The woman in the insurance part of the clinic said that they do that ...give oks and take them back.
I see the doctor on the 11th and will ask him if they ever give in again. His nurse has had the insurance department apply for drug replacement for me and I guess they are waiting to hear.
While I am not stage 4, both I and my onc believe that without herceptin, I would recur right away. No proof, just all the lab reports, etc.
Thank you for your input. ma