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the insurance refuse to give my mom Tarceva


cclin001

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My mom is in Taiwan  and has stage 4 non small lung cancer with EGFR mutation.  She is on Tarceva since August and have improved a lot.  The CEA value has decreased from 50 to 16.  The current CT scan shows that her tumor in her brain has shrink a little.  But some of her tumors in her lung grows and some of them shrink.   The insurance company in Taiwan just decided the effect is not tremendous to qualify the treatment.  Now, what can we do?  I am afraid that the tumor may grow back and her symptoms like coughing and pain on her shoulder and lung will come back soon.    Tarceva is so expensive that we can not afford without any aid.  Does any one know whether we can get a great discount if the insurance won't pay it even outside US.

 

Chihchang

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Chihchang,

 

Try contacting Genetech, the maker of Tarceva, and enrolling in their Financial Assistance program.  Here is where you can find the information - http://www.tarceva.com/patient/support/financial-assistance

 

Stay the course.

 

Tom

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  • 2 months later...

My mom has stopped Tarceva since the end of October.  She tried some alternative method and it was not working.   Her tumors in brain has affected her function in recognition, memory and movement of her body.  We brought her to ER and she stayed in the hospital for two weeks.  The doctors gave her Tarceva again and the tumors began to shrink right away just like a magic.  She has since improved a lot both in body movement and thinking.  But we still need to get the insurance company's approval for the usage of Tarceva,  Last time when we could not get Tarceva, I have tried to contact Genetech,  then Roche in Taiwan and the parent Roche in Europe.  But no one can help me.  I hope that this time the insurance company can approve the medicine basing on our current CT scan results.

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Chihchang,

 

I am so sorry you and your mom have to go through this nightmare.  And so, you've arrived at the conjunction between lung cancer and insurance.  It appears to be a nightmare worldwide.  

 

I had a friend who was just about to start his second line chemo treatment.  He's primed for the fight of his life:  ready, set....stop, insurance.  Seems like the insurance company didn't like the single recipe Gemzar his oncologist prescribed.  Gemzar is normally administered in a 2 cocktail combination with carboplatin or some form of platinum based chemo as a second drug.  But, my friend was allergic to carboplatin.  That didn't seem to matter to the insurance company!

 

The problem with insurance is they want to fit all kinds of people, with all kinds of problems into one solution.  This least common denominator approach doesn't work because...surprise...people are unique.  But insurance doesn't cover people; it is a business providing profits to stock holders.  The coverage is the profit machine.  So, one pays a premium, co-pay for diagnostic and consultation visit, and gets denied treatment on the back end.  That is the formula for maximizing profit.

 

Our problem, on reflection, is not people being covered by health insurance but health insurance companies denying coverage! 

 

Stay the course.

 

Tom

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  • 2 weeks later...

Dear Tom,

 

Thanks for your comment.  I agree with you that each patient is unique and the best treatment should be tuned to each individual case.  However, I doubt that this is possible at this moment as cancer becomes almost the number one or number two killer disease all over the world and there are so many patients with different cancers.  When my mom started with Tarceva again, I witnessed this unbelievable effectiveness of this drug.  I know that this industry really has made some significant contribution on cancer treatment and I appreciate that.  Just the price of this drug is so high that it is really a burden for many people if the insurance can not cover it.  This is particularly true when people at this stage needs to spend quite a lot in everything, including hiring someone to assist their daily life.

 

Chih-Chang

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