trish2418 Posted March 8, 2006 Share Posted March 8, 2006 After amazing results on Taxotere, my onc wants to add Avastin to the Taxotere for 3 more rounds of treatment. My insurance co. (United Health Care) told my onc that they will not cover Avastin for me because the FDA protocol just recently approved is Taxol, Carboplatin & Avastin. I've had reactions to both Taxol & Carbo and obviously can't take either. Taxotere has been a miracle for me. The UHC folks are sticking to their guns but did allow for 3rd party review -- 3rd party to be chosen by them. I've seen some people here on Taxotere/Avastin. Are you part of a clinical study? Did you have problems getting that combo approved? Did you have to resort to threatening letters from attorneys? Any advice you can give me would be greatly appreciated. Thanks, Trish Quote Link to comment Share on other sites More sharing options...
mamasbabygirl Posted March 8, 2006 Share Posted March 8, 2006 Oh, this just makes me sick. INSURANCE COMPANIES NEED TO MAKE DECISIONS ON A CASE BY CASE BASIS, NOT JUST PROTOCOL. If I can help you with anything in getting your meds, let me know. Prayers... Quote Link to comment Share on other sites More sharing options...
melindasue37 Posted March 8, 2006 Share Posted March 8, 2006 Hi Trish, I just talked to my step dad about the Avastin. He said that we got the Avastin approval through Medicare. I do know that when my parents were down in Florida they had a heck of a time trying to deal with the doctor and trying to get it approved. In Illinois, we haven't had any problems at all. I'm not sure what state you live in, or if you qualify for Medicare, but as I said....we didn't have any problems getting it approved here in Illinois. Please let me know if you have anymore questions. I would love to help you in any way that I can. Melinda Quote Link to comment Share on other sites More sharing options...
midge Posted March 8, 2006 Share Posted March 8, 2006 It costs about $16,000 per infusion and many insurance companies refuse to pay because it IS NOT approaved for lung cancer treatment, although it soon will be. My insurance company pays it thank God but I was told that is it didn't they (oncolgist office) would contact the drug company and see if they would work out something to profide it to me...check this out, I am sure it can be done. Quote Link to comment Share on other sites More sharing options...
ginnyde Posted March 8, 2006 Share Posted March 8, 2006 Trish, check to see if the drup mfg. has a compassionate use program. Quote Link to comment Share on other sites More sharing options...
Don Wood Posted March 8, 2006 Share Posted March 8, 2006 I second Ginny's suggestion. When Iressa first came out, our onc went to the manufacturer direct to line us up with it, and convinced Medicare to cover it. It is worth a try. Don Quote Link to comment Share on other sites More sharing options...
RandyW Posted March 8, 2006 Share Posted March 8, 2006 This is a link to some Info on avastin financial assistance. I was looking into this possibility when Deb passed because she was supposed tostart this treatment the day she passed away. Good Luck. I hope this might be a start for something http://www.avastin.com/avastin/resource ... rsment.pdf Quote Link to comment Share on other sites More sharing options...
hollyanne Posted March 9, 2006 Share Posted March 9, 2006 Here is the deal with Avastin: Medicare: Every state administrator determines if they will cover it. For example, in Utah where my mom was - it was not covered, yet in Illinois it is covered. Reimbursement: There is a SPOC program which assists in payment -- yet the drill at most cancer centers is that the patient must agree to pay for the infusion, and then it is sent to the SPOC program for reimbursement...and they may not approve it if it is not the same protocol from the original study that showed some success. Unfortunately, I did a lot of investigation on this with my mom's cancer center.....you can try the legal route, yet I do know that the answer will be that Avastin is approved by some insurance comopanies as a first line LC treatment only if delievered with the chemo drugs from the most recent study. Good Luck. It does suck. Quote Link to comment Share on other sites More sharing options...
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