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01-12-2010, 10:32 AM
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#1
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Senior Member
Join Date: Nov 2007
Location: New Jersey
Posts: 889
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Re: Please help! Tykerb has been denied by CVS Caremark
I am curious to see what is going to happen to me now. My onc is switching me to tykerb/xeloda due to yet another progression. I also have CVS Caremark. I am anxious to see if they approve this since Sheila said they would have for her. Good luck Barb.
__________________
dx aug 03 invasive dcis 1 cm
er/pr/her2+
bcs 8/4/03
bcs 8/21/03 0/16 nodes
tx 4x ca 36 rad tam
postmenopausal 06 aromasin
sept 07 biopsy node in neck
muga/pet/cat/bone mets to lungs nodes and liver stage iv
tx hki-272
tx not working switched to taxol herceptin
Taxol not working switched to navelbine
navelbine is causing bad neuropathy
starting gemzar
gemzar quit on me now on Ixempra due to increasing number and size of liver mets
another progression starting tykerb/xeloda
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01-12-2010, 10:49 AM
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#2
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Senior Member
Join Date: Aug 2003
Location: Morris, IL
Posts: 3,507
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Re: Please help! Tykerb has been denied by CVS Caremark
WOS
You should be able to get the Tykerb/Xeloda with no problems..its when they want to give the Tykerb with Herceptin that CVS has issues....Barb emailed me and I faxed her husband 23 pages of appeal info I used....hoping it works for her as it did for me!
Hoping the Tykerb/Xeloda is a good new combo for you WOS~~~
__________________
"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
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01-12-2010, 03:36 PM
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#3
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Senior Member
Join Date: Feb 2006
Location: Southern, CA
Posts: 2,511
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Re: Please help! Tykerb has been denied by CVS Caremark
I do not want to take this thread off topic...but looks like Shelia has helped her out. But can someone tell me WHY CVS or any pharmacy would have a say in what drug your allowed to have? The drugs/medications we are prescribed are from our doctors...not our pharmacy...so how are they allowed to stick their nose in our business?
I'm using CVS...but I pick up my meds at the store so far. But if you use their prescription mail order plan then they can deny your meds/drugs? This doesn't seem right...these drugs can be a matter of life and death. How are they allowed to do this? We have enough stress in our lifes without worrying about getting a notice at the last minute saying you can't have your prescription. Unbelieveable.
Chelee
__________________
DX: 12-20-05 - Stage IIIA, Her2/Neu, 3+++,Er & Pr weakly positive, 5 of 16 pos nodes.
Rt. MRM on 1-3-06 -- No Rads due to compromised lungs.
Chemo started 2-7-06 -- TCH - - Finished 6-12-06
Finished yr of wkly herceptin 3-19-07
3-15-07 Lt side prophylactic simple mastectomy. -- Ooph 4-05-07
9-21-09 PET/CT "Recurrence" to Rt. axllia, Rt. femur, ilium. Possible Sacrum & liver? Now stage IV.
9-28-09 Loading dose of Herceptin & started Zometa
9-29-09 Power Port Placement
10-24-09 Mass 6.4 x 4.7 cm on Rt. femur head.
11-19-09 RT. Femur surgery - Rod placed
12-7-09 Navelbine added to Herceptin/Zometa.
3-23-10 Ten days of rads to RT femur. Completed.
4-05-10 Quit Navelbine--Herceptin/Zometa alone.
5-4-10 Appt. with Dr. Slamon to see what is next? Waiting on FISH results from femur biopsy.
Results to FISH was unsuccessful--this happens less then 2% of the time.
7-7-10 Recurrence to RT axilla again. Back to UCLA for options.
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01-12-2010, 04:09 PM
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#4
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Senior Member
Join Date: Sep 2005
Location: Newton, MA
Posts: 951
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Re: Please help! Tykerb has been denied by CVS Caremark
Hi Chelee,
I spent a lot of time on the phone yesterday to Caremark.
Apparently when my husband's work switched to Caremark, they authorized this pharmacy to only approve drugs that meet the protocol. Therefore, I was denied. My husband is currently discussing the issue with his work, and my oncologist is also appealing the case. Sheila has also sent me information that should help my personal appeal, if this is not solved in the next few days. I am also considering switching to the health care plan my school system offers. Up until now I didn't want to do that in case I had to leave work.
I believe that this could be a major issue for all of us in the future as more targeted therapies are developed that may only be available in the form of tablets.
Best regards,
Barbara H.
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01-12-2010, 08:09 PM
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#5
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Senior Member
Join Date: Nov 2004
Location: Misty woods of WA State
Posts: 4,128
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Re: Please help! Tykerb has been denied by CVS Caremark
Gee, Barbara -
I am appalled at your treatment by a *gosh darn pharmacy.* Guess I assumed you had your health plan through your school, but see where if you had an alternative that might be better.
Your time to fight this is limited due to your work, so I hope you will have a resolution quickly!
The health plans need to reclassify or create a NEW classification for some of these new drugs.
Best thoughts coming your way on this one.
__________________
"When I hear music, I fear no danger. I am invulnerable. I see no foe. I am related to the earliest times, and to the latest." H.D. Thoreau
Live in the moment.
MY STORY SO FAR ~~~~
Found suspicious lump 9/2000
Lumpectomy, then node dissection and port placement
Stage IIB, 8 pos nodes of 18, Grade 3, ER & PR -
Adriamycin 12 weekly, taxotere 4 rounds
36 rads - very little burning
3 mos after rads liver full of tumors, Stage IV Jan 2002, one spot on sternum
Weekly Taxol, Navelbine, Herceptin for 27 rounds to NED!
2003 & 2004 no active disease - 3 weekly Herceptin + Zometa
Jan 2005 two mets to brain - Gamma Knife on Jan 18
All clear until treated cerebellum spot showing activity on Jan 2006 brain MRI & brain PET
Brain surgery on Feb 9, 2006 - no cancer, 100% radiation necrosis - tumor was still dying
Continue as NED while on Herceptin & quarterly Zometa
Fall-2006 - off Zometa - watching one small brain spot (scar?)
2007 - spot/scar in brain stable - finished anticoagulation therapy for clot along my port-a-catheter - 3 angioplasties to unblock vena cava
2008 - Brain and body still NED! Port removed and scans in Dec.
Dec 2008 - stop Herceptin - Vaccine Trial at U of W begun in Oct. of 2011
STILL NED everywhere in Feb 2014 - on wing & prayer
7/14 - Started twice yearly Zometa for my bones
Jan. 2015 checkup still shows NED
2015 Neuropathy in feet - otherwise all OK - still NED.
Same news for 2016 and all of 2017.
Nov of 2017 - had small skin cancer removed from my face. Will have Zometa end of Jan. 2018.
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01-13-2010, 06:33 AM
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#6
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Senior Member
Join Date: Nov 2007
Location: New Jersey
Posts: 889
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Re: Please help! Tykerb has been denied by CVS Caremark
Thanks Sheila, right after I read your post I got a call from Caremark saying it was approved. It is going to cost me 1,101.00 for the 1st month. After my deductible is reached and my out of pocket, the cost should come down. If not I will definitely need some help paying for this.
__________________
dx aug 03 invasive dcis 1 cm
er/pr/her2+
bcs 8/4/03
bcs 8/21/03 0/16 nodes
tx 4x ca 36 rad tam
postmenopausal 06 aromasin
sept 07 biopsy node in neck
muga/pet/cat/bone mets to lungs nodes and liver stage iv
tx hki-272
tx not working switched to taxol herceptin
Taxol not working switched to navelbine
navelbine is causing bad neuropathy
starting gemzar
gemzar quit on me now on Ixempra due to increasing number and size of liver mets
another progression starting tykerb/xeloda
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