Deny coverage for Pertuzuman (Perjeta)

[Nguyen]

Hello,

We receive a letter from the insurance company yesterday denying coverage for Pertuzumab with the following reason:

"There is no indication your patient has had no prior chemotherapy for metastatic disease - AND - no prior anti-her2 therapy [i.e Herceptin (trastuzumab)]."

I am not sure how to intepret this double negative. Does this mean Pertuzumab is approved only for metastatic patient WITHOUT prior chemo and herceptin?

OR, the reverse which is Pertuzumab is approved only for metastatic patient WITH prior chemo and herceptin.

Many thanks for your input as we start to fight the insurance battle again,

Nguyen