HER2 Support Group Forums - View Single Post - Insurance Company Does Not Want to approve TYKERB

Sheila · 10-20-2009, 05:33 AM

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~~~

10-20-2009, 05:33 AM	#52
Sheila Senior Member Join Date: Aug 2003 Location: Morris, IL Posts: 3,507	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~~~ __________________ "Be kinder than necessary, for everyone you meet is fighting some kind of battle." Hugs & Blessings Sheila Diagnosed at age 49.99999 2/21/2002 via Mammography (Calcifications) Core Biopsy 2/22/02 L. Mastectomy 2/25/2002 Stage 1, 0.7cm IDC, Node Neg from 19 nodes Her2+++ ER PR Neg 6/2003 Reconstruction W/ Tissue Expander, Silicone Implant 9/2003 Stage IV with Mets to Supraclavicular nodes 9/2003 Began Herceptin every 3 weeks 3/2006 Xeloda 2500mg/Herceptin for recurrence to neck nodes 3/2007 Added back the Xeloda with Herceptin for continued mets to nodes 5/2007 Taken Off Xeloda, no longer working 6/14/07 Taxol/Herceptin/Avastin 3/26 - 5/28/08 Taxol Holiday Whopeeeeeeeee 5/29 2008 Back on Taxol w Herceptin q 2 weeks 4/2009 Progression on Taxol & Paralyzed L Vocal Cord from Nodes Pressing on Nerve 5/2009 Begin Rx with Navelbine/Herceptin 11/09 Progression on Navelbine Fought for and started Tykerb/Herceptin...nodes are melting!!!!! 2/2010 Back to Avastin/Herceptin 5/2010 Switched to Metronomic Chemo with Herceptin...Cytoxan and Methotrexate Pericardial Window Surgery to Drain Pericardial Effusion 7/2010 Back to walking a mile a day...YEAH!!!! 9/2010 Nodes are back with a vengence in neck Qualified for TDM-1 EAP 10/6/10 Begin my miracle drug, TDM-1 Mixed response, shrinking internal nodes, progression skin mets after 3 treatments 12/6/10 Started Halaven (Eribulen) /Herceptin excellent results in 2 treatments 2/2011 I CELEBRATE my 9 YEAR MARK!!!!!!!!!!!!! 7/5/11 begin Gemzar /Herceptin for node progression 2/8/2012 Gemzar stopped, Continue Herceptin 2/20/2012 Begin Tomo Radiation to Neck Nodes 2/21/2012 I CELEBRATE 10 YEARS 5/12/2012 BeganTaxotere/ Herceptin is my next miracle for new node progression 6/28/12 Stopped Taxotere due to pregression, Started Perjeta/Herceptin