Steff Posted April 6, 2021 Share Posted April 6, 2021 Hi all, I am looking for some help....after 5 years of lung cancer treatments and having ZERO difficulty with insurance (my mom has Medicare and private secondary insurance), we have come to our first road block. It is in relation to her suggested maintenance treatment for her newly diagnosed leukemia. I know that many of you have had insurance issues and I am just wondering how to proceed. Any help is appreciated! Here is the rundown - my mom was successfully treated for Treatment-Related Acute Myeloid Leukemia (yes, her leukemia is from her previous lung cancer treatments, but don't worry, we have been told that leukemia related to lung cancer treatment occurs in less than 1% of cases). Luckily, she has been in remission from her first induction treatment. Unfortunately, she does not qualify for a bone marrow transplant because she needs oxygen to exercise (darn that lobectomy!), but she has a mutation that has a targeted therapy. While this targeted therapy is typically taken with initial chemo to help with remission, her prescribed treatment is for maintenance, after treatment has ended. This is a relatively new way to try to keep a patient in remission and apparently can be quite successful. Long story short...even after appeal, Medicare (and then ultimately the secondary insurance) has denied the drug. Their reason is because she will be taking a larger dose than normally prescribed and for a longer period of time. Again, this isn't a typical use for the drug and I am not finding that there is a similar clinical trial for her to take part in. Unfortunately, all of the trials are for folks who are in initial treatment, unable to reach remission, or have relapsed. At this point, my mom does not fit into any of those categories. Do you have any advice on how to try to get insurance to approve a life-saving drug to be used in an a-typical fashion? Thanks in advance for your help, Steff Quote Link to comment Share on other sites More sharing options...
Join the conversation
You can post now and register later. If you have an account, sign in now to post with your account.