$2100???

SoCalGal · 05-10-2007, 09:51 AM

Did you have to pay the same percentage for your other chemo? Why just this one?

Lolly · 05-10-2007, 04:10 PM

Joy, I ran into the same problem with my insurance which is a Medicare based plan. They view Tykerb as a "Specialty Drug" and it's at the highest copay. I was told I could apply for an "Exception" for Tykerb, the paperwork would take a couple of weeks, but no guarantee it would be approved.

The crime here, IMHO, is that insurance companies are allowed to classify oral chemotherapies as prescription meds and can therefore charge a higher copay, whereas infused chemo's are normally covered at 100% or close to it depending on the plan.

Seriously, there oughta-be-a-law!!! Maybe we're the ones who will have to advocate for a change!

Joy, I am shocked and dismayed for your sake. Ask about an appeal of the coverage offered, see if they can offer an exception.

And please don't give up hope.

<3 Lolly

Mary Jo · 05-10-2007, 05:22 PM

Oh my gosh.......on top of all the other worries one should NOT have to worry about those insurance companies and all the games they play. That is almost more frustrating than the cancer, ya know?

I'm sorry for those who have that trouble on top of the other troubles.

Hugs,

Mary Jo

Jean · 05-10-2007, 05:48 PM

One would think that since Tykerb is oral it would also cost less
to administer verses the other chemo's which require infusions, staff and
nurseing attendance..hospital or cancer center operation costs...how
does the insurance carriers get away this and justify this rational?
No one in our country should have to be charged that sum of money monthly
to have their meds....we spend billions out of the states...Charity begins
at home..here in the good USA....I can't understand why the rich and famous
are not aware that many people right here need help!

Jean

Joy · 05-10-2007, 07:05 PM

I love you guys. I do think, as Lolly said, that we may need to be the ones who advocate for change. As one of my best friends said, "You know, a lot of money, time and hard work goes into developing these drugs to help people with these diseases and yet no one can afford to buy them."

I am going to write a letter to the insurance company mentioning the fact that they seemed willing to cover herceptin weekly (not cheap) at 100%. So "WHAT UP?" with Tykerb. I'm also going to take them up on their offer of a nurse case manager, which I don't really need, but now maybe I'll have one central person.

And, of course, my AMAZING family is willing to help get me on this drug. Even my ex-husband said that he'd charge it to at least get started and hopefully the Patient Access Network Foundation will approve me and can help with most of this. Which all seems dumb because I do have insurance and I'm not wanting to take advantage of other programs that other people probably need more than me. But as I have felt like a loser all day that I can't buy my own meds, my friends and family have reminded me that virtually no one can pay $2100/month for meds.

Meanwhile the little cancer cells just go unchecked. And I'm frustrated and yet I know that people all over have much harder circumstances, much less help or even love and that really makes me sad. I'm one of the lucky ones. 'specially 'cause I have you guys.

hutchibk · 05-10-2007, 08:22 PM

You are in the hell that I was in last week. This week has been a new kind of hell. Anyway, back to what I learned in last week's hell. Because Tykerb (and in my case Xeloda) are oral, they do not get charged to your insurance under the medical portion of the plan like infused chemo. The are considered prescription and charged to your prescription benefit. My script benefit is $1500 for the whole year! LOL. I was also mortified to learn that I would owe upwards of $2200 for each, Ty and Xel, each month! I promptly called my oncologist's nurse, who promptly put me in touch with the patient assistance and advocacy nurse at my cancer clinic who did the homework, made the calls, and found out how to apply me for the GSK and Roche assistance programs. Were it not for her, I would not have known what to do. Call your onc's office, tell them what you have learned about your co-pay, and ask if they have a patient advocate assistant who knows the ropes and can help you out. At my clinic, this is her specific job, and she is awesome. In lieu of her, I would have gone straight to the clinic social worker.

Jeanette · 05-10-2007, 08:31 PM

Shiela, my prayers go out to you and your friend. I have a friend that I have had for over 40 years and guess what ,we were diagonosed with cancer the same day.Hers is in the colon and mine was breast . We raised our kids together and have went thur hell together. With all the radation she has had she is now in a wheelchair. We hold onto each other dearly and have talked about what could happen' All we both ask if and when the time comes is to go in peace with our families with us. I certainly hope your friend is at peace with herself. My prayers go out to you both, Jeanette