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Lani · 05-20-2008, 12:54 PM

I don't see a profile for you so we could know when you were diagnosed, whether you have inflammatory bc or regular her2+ bc, what stage you are, how many lymph nodes were positive, how long you have been on herceptin already, what you scans, tumor markers or serum her2 ECD results have been.

Insurance companies usually want your treatment to follow recommendations of national panels of oncologists or the "standard of care" agreed to by oncologists at national meetings and usage of the medication in question in line with the indications for which it met FDA approval.

If there are any treatments not given as part of a clinical trial and not meeting the usual "standard of care" they usuallly want a letter from your treating doctor as to why your case is different and they usually send it to a panel of doctors who may or may not be expert in the area and who don't know your particular case as well as you do. If you and your doctor can summarize your particulars and give good reasons why the continued treatment is "medically necessary" they may or may not agree, but it is worth a try.

If you are Stage IV I am happy to try to provide you with citations of articles as to why you should remain on herceptin indefinitely although NED, just adding other drugs to it.

Hope some of this helped.

05-20-2008, 12:54 PM	#7
Lani Senior Member Join Date: Mar 2006 Posts: 4,783	Mary Anne I don't see a profile for you so we could know when you were diagnosed, whether you have inflammatory bc or regular her2+ bc, what stage you are, how many lymph nodes were positive, how long you have been on herceptin already, what you scans, tumor markers or serum her2 ECD results have been. Insurance companies usually want your treatment to follow recommendations of national panels of oncologists or the "standard of care" agreed to by oncologists at national meetings and usage of the medication in question in line with the indications for which it met FDA approval. If there are any treatments not given as part of a clinical trial and not meeting the usual "standard of care" they usuallly want a letter from your treating doctor as to why your case is different and they usually send it to a panel of doctors who may or may not be expert in the area and who don't know your particular case as well as you do. If you and your doctor can summarize your particulars and give good reasons why the continued treatment is "medically necessary" they may or may not agree, but it is worth a try. If you are Stage IV I am happy to try to provide you with citations of articles as to why you should remain on herceptin indefinitely although NED, just adding other drugs to it. Hope some of this helped.