Re: Insurance Company Does Not Want to approve TYKERB
 

As I understand Genentech's program for those without insurance or underinsured they just replace the Herceptin supply of the oncologist who supplies it to you, so wouldn't the easiest solution be to get the prescriptions for the tykerb and xeloda, get your oncologist to get Genentech to replace the herceptin you use and just find the diarrhea or hand and foot symptoms from the xeloda intolerable???

Would only require help from Genentech since GSK is slow in getting back to you.

Re: Insurance Company Does Not Want to approve TYKERB
 

Sheila,
I see some suggestions to go on the Tykerb/Xeloda while you push for that dumb insurance co to approve the Herceptin. You know that Herceptin has a long half life (21 days I think), so you would almost be starting the combo you seek. The Xeloda might even work in conjunction with Tykerb even though it finally pooped out with Herceptin.

I don't remember how long you've been off the Xeloda, but remember it worked really well for you, and if you've had a long enough holiday from it, who knows.

Don't give up on the T/H.

Re: Insurance Company Does Not Want to approve TYKERB
 

Sheila,

Please find more people to advocate for you. Call the American Cancer Society, Susan B Komen, your US Senator, and US Congressperson. You can also try your state Insurance Commissioner. I would even call my local and state newspaper. This is OCTOBER after all.

I know what it is to fight these companies. I have done it and have given up. They say no until you say "uncle".

I hope you get successful results.

Marilyn

Re: Insurance Company Does Not Want to approve TYKERB
 

Sheila,

I love the picture of your granddaughter, what a sweetheart.

I am so sorry that you keep running into all of these roadblocks. I hope some of the suggestions being made will be a temporary solution, until you get your insurance company to get their head out of "you know where"!

I am thinking of you, as always!

Love,

Alice

Re: Insurance Company Does Not Want to approve TYKERB
 

Second appeal denied. I have made lots of calls, and so I wait.
Thank you all for all your suggestions, i have looked into most, still with no help. My patience is wearing thin. Hoping tomorrow is a new day.

Re: Insurance Company Does Not Want to approve TYKERB
 

Sheila

I am so sorry to hear what you are going through. I can completely understand, as fighting all of this red tape is something I have had to undergo lately with trials.

Since I was kicked off of the DMI trial due to my bilirubin (and my latest blood work showed it is now down to normal, I am beginning Herceptin long with Tykerb and my insurance company did not give me any trouble just with the tykerb. I did not know that it has to be in combination with Xeloda.??

I wish you all of the luck in getting it. Like the others have said, have your onc. check on it for you.

I am so angry myself Sheila. I did so well on the DMI and since I have been off, I now have 6 tumors back in my liver. I understand Genetech's position, but give me a break. I found something that shrunk 16 tumors (never happened to me before ) and now look. My nerves are so frazzled that I am on the verge of tears always , so I know what you are going through.

Take care my friend - there will be a resolve for you.

Re: Insurance Company Does Not Want to approve TYKERB
 

Under these absurd circumstances recommend you take the rx for both, take the one you want and give the other to someone else here that needs help. I don't doubt they are here.

Anyone heard of the underground network that tries to pass on unused drugs to those in need?

Re: Insurance Company Does Not Want to approve TYKERB
 

have you told them that Medicare pays for it?

Re: Insurance Company Does Not Want to approve TYKERB
 

I think you should get very vocal and contact some news media outlets. Now is a very sensitive time for them to be denying treatment. I'd take full advantage of that.

Re: Insurance Company Does Not Want to approve TYKERB
 

Excellent idea Brenda!!

The squeaky wheel is always the one that gets the grease . . . and in this case, hopefully the Tykerb!

Re: Insurance Company Does Not Want to approve TYKERB
 

Sheila,
I agree, rattle as many cages as you can. In the meantime, could you pull it off financially paying for either the Tykerb/Xeloda or the Herceptin (since BCBSIL's issue seems to be paying for the combo) while you're working it. You know the insurance co is not paying what they are billed for the Herceptin - you might be able to work a deal with patient services to get a reduced rate.

It totally sucks - you do everything right: HAVE insurance all those years, bust your ass surviving as long as you have and now they poop on you. Your job is to fight - the disease, not your insurer! Theirs is to support that by paying for FDA approved therapies.

Sheila, a door will open - keep jiggling the handles.

Re: Insurance Company Does Not Want to approve TYKERB
 

Update on this continuing saga. I have gone through Tykerb Cares, Gsk, appeals etc and the insurance won't budge. Seems I dont qualify for the Tykerb program as I have insurance. Since the Onc. based her whole appeal on my Xeloda failure in previous use (14 mos.) , they will NOT give it to me. I called my husbands company, which is the Electrical utility here in Illinois to see if they can override the insurance snafu....
At one point yesterday, I actually asked CVS/Caremark, our Prescription plan how much the drug would cost me out of pocket. She replied the PPO Reduced wholesale price is around 7000.00 a month....I of course told her that if it wasnt for them denying me Abraxane and me getting Taxol instead, resulting in missing eyebrows, short gray hair and extra weight gain I got from the steroids etc, I might of been able to raise that much prostituting myself for cancer drugs....there was pure silence. So as I wait for the Electric Company to make a decision, I have a choice of either going on Doxil, which will take me off herceptin or trying to get into a T-DM1 trial in Detroit if I can....

Brenda, They do know that medicare pays and they dont care.
Not going down wiithout a fight~~~

Re: Insurance Company Does Not Want to approve TYKERB
 

Sheila,

Oh.... I am sooo MAD. This is wrong in so many ways. Please continue to hang tough.... (easy for me to say). You will get what you need and I am so sorry that you must go through this.

Love, Hope, Peace, Carolyn

Re: Insurance Company Does Not Want to approve TYKERB
 

Sheila, what can we do to help you?

Re: Insurance Company Does Not Want to approve TYKERB
 

Sheila,

Is there still a possibility of getting BOTH drugs (of the pair they approve) but only taking the one?

Then getting the Herceptin from Genetech as Lani suggested...

TRS

Re: Insurance Company Does Not Want to approve TYKERB
 

SHEESH! Where is a knight in shining armour when you need one??? Lets hope the electric company can shock the insurance into cooperating!

I was wondering, as Teri just posted, if your onc can backtrack and ask for the Tykerb with Xeloda combo even though she first prescribed without the Xeloda?

Any word on the Decater T-DM1 trial opening?? I am sure you have been bugging them.

Sending big cyberhugs and positive energy to help you get through this quagmire ...

Re: Insurance Company Does Not Want to approve TYKERB
 

The insurance company will not pay for the Xeloda now either, due to the fact that both appeals from my onc. were totally based on Xeloda failure as I was on it for 14 months. I have called 2 clinical trials today...still waiting.

Re: Insurance Company Does Not Want to approve TYKERB
 

Dang it Sheila.......I'm so sorry. How frustrating and sad that others feel that can dictate or play with our lives.

Praying and hopeful...

Mary Jo

Re: Insurance Company Does Not Want to approve TYKERB
 

Sheila, wish I could offer advice or suggestions, but thinking of you and hoping for a result!

Re: Insurance Company Does Not Want to approve TYKERB
 

This is crap. A few chioce words race through my head as I read your posts about the insensitivity of the insurance company. You gave CVS/Caremark a little shock treatment with your prositution suggestion... This attitude serves you well. Stay strong, never give up.

Who or what will influence these insurance companies???

My idea, Sheila--draft letter explaining the denial. You (or Joe) will be able to explain it more concisely. Send us the address of your insurance company (name names). We can cut and paste your letter to our own letterhead and mail it individually demanding a resolution. It's worth a shot.

Stay strong.

Love you,
Dana