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mts · 01-02-2007, 10:08 AM

When I went on Herceptin, it was still only FDA approved for Stage IV...
I was Stage I.

The way I understand what happened with me getting Herceptin before it was FDA approved was basically the onc providing it to me.

Anyone can call their insurance company and ask them to tell you if Tykerb is on their list of allowed drugs. If the insurance is paying for Tykerb for Stage IV; it will likely pay for any other stage as well. Call customer support to hear what your insurance can do and relay that info to your onc. I found that I got more out of it if I made the call and not the onc's billing clerk. When the onc's bill the insurance, they just enter the ICD-9 code for "breast cancer" without mention of stage. Herceptin and Tykerb are billed as chemo...

In the end, the 4th onc I consulted with gave Herceptin to me because I insisted... I was well into my Herceptin Tx when it was finally FDA approved for early stage.

Because of Herceptin's dramatic success, and Tykerbs early findings, one would think the onc's would be more apt to provide Tykerb when we ask for it -regardless of Stage. I know they want to make sure the drug is safe and all that stuff, but so far, the side effects are less traumatic than Herceptin!

Either way- it will be up to the onc!

Maria (MTS)

01-02-2007, 10:08 AM	#6
mts Senior Member Join Date: Sep 2005 Location: Central Florida Posts: 503	Insurance and "Off Label" -- From Herceptin to Tykerb When I went on Herceptin, it was still only FDA approved for Stage IV... I was Stage I. The way I understand what happened with me getting Herceptin before it was FDA approved was basically the onc providing it to me. Anyone can call their insurance company and ask them to tell you if Tykerb is on their list of allowed drugs. If the insurance is paying for Tykerb for Stage IV; it will likely pay for any other stage as well. Call customer support to hear what your insurance can do and relay that info to your onc. I found that I got more out of it if I made the call and not the onc's billing clerk. When the onc's bill the insurance, they just enter the ICD-9 code for "breast cancer" without mention of stage. Herceptin and Tykerb are billed as chemo... In the end, the 4th onc I consulted with gave Herceptin to me because I insisted... I was well into my Herceptin Tx when it was finally FDA approved for early stage. Because of Herceptin's dramatic success, and Tykerbs early findings, one would think the onc's would be more apt to provide Tykerb when we ask for it -regardless of Stage. I know they want to make sure the drug is safe and all that stuff, but so far, the side effects are less traumatic than Herceptin! Either way- it will be up to the onc! Maria (MTS)