Jump to content

Insurance refused Iressa coverage for me today


Grumpy-One-Lung

Recommended Posts

Hi All

I have a question concerning Iressa and Insurance. Has anyone been denied payment?

I was given a prescription today for Iressa and was told that it was not covered under my insurance.

I have very good coverage and just can’t believe that I was refused. HELP.

I will be calling my doctor and insurance company in the morning, just thought maybe someone out here might be able to offer me a bit of guidance on this.

I refused Chemo today so I got the Iressa instead for a trial run (for me). Then I was refused.

Grumpy One Lung (e-mail at grump3980@comcast.net If you wish or on the board

Link to comment
Share on other sites

My Mom's doctors office called the drug company and got information for my mom and dad to get assistance. As it turns out they have too many assets... so they have to pay for the prescription. Depending on your income you might be able to get help that way. There is a form to fill out. I feel for you. My mom's doctor said he is embarassed to prescribe Iressa it is so expensive. He said over and over how rediculously expensive it is. It upsets me just thinking about it because this could be the difference towards this horrible disease. I told Dad sell the land, do whatever you have to do to get mom the medicine she needs!! I just hate people being taken advantage of and that is what the drug companies are doing!

I am sorry I am not much help... I hope you are eligible for assistance in some way.

Gayle

Link to comment
Share on other sites

Grumpy,

This could be totally off, but do you think maybe your insurance company is behind the times and still has Iressa listed as unapproved drug. I realize it was approved back in May, but anything is possible with an insurance company's processing requests. I was on Iressa, but through a clinical trial, so my insurance company was charged through that process rather than as a prescription. I have to bet there's a way around your being able to be covered for its use.

Good luck with this,

Margaret

Link to comment
Share on other sites

My insurance also denied iressa until my oncologist communicated with them that it was a 3rd line defense after radiation and chemo. I think that is the only way it is covered (after radiation & chemo). By the way only been on a few days but no side effects as of yet!!

Link to comment
Share on other sites

Medicare covers IV drugs, e.g. standard chemo, that are given in an outpatient setting, but not pills that you can take at home. Is that the problem with your insurer? I suggest calling them and 1) finding out why they don't cover it and 2) appealing their decision if necessary. Good luck!

Link to comment
Share on other sites

Our insurance covered it with pre-approval. The onc called the insurance and the insurance called the drug store. The drug store did not have it on hand but did order it and we had it the next day.

You should check with your ins. co to see if you need the pre-approval.

Deb

Link to comment
Share on other sites

I had a 90 day supply of Iressa plus a 14 day supply that was for my husband Buddy. He did use some of the 14 day supply before he was taken off of it and passed away. About two weeks ago i contacted his onc doctor and took the 90 day supply to him hoping he could find someone who couldn't afford it to use it or whoever needed it. If you pm me I will be glad to give you the dr's name and phone number and address and possibly your doctor could call him and possible he may still have it. It had a shelf life until I believe it was Sept or Oct 04.

Link to comment
Share on other sites

I now have a comeback for anyone who says "Money means nothing". My remark will be "Unless you need a cancer drug to stay alive that your insurance company won't pay. What? You say then sue the insurance company? I agree that is a possibility, but that costs money too."

I can't wait to use that line.

I have a warped sense of humor now and get a kick out of shocking people. Yest we went to one of those sit through an hour presentation and get a free prize. I made the guy mad b/c I said "yes, vacations are important, but my mom has cancer, that is more important, we are really just here for the prize" :) It was worth the prize, it is two nights free at Disneyland Resort and two disneyland tickets. My close friend who insisted on flying out to my wedding is coming back to CA to vacation, she loves Disney, so it was worth my hour :)

Link to comment
Share on other sites

We have Aetna US Healthcare and they too denied Iressa the first time through. Then our wonderful onc. got them the right info for them to approve. Don't know what he said but it worked.

I would keep pushing and pushing and pushing, Iressa is not experimental.

Ginny

Link to comment
Share on other sites

Hi again

Thank You All so Much for your great help and kindness. What a wonderful group we all have here. No where else in the world could one find so many fun, caring, helpful people as you all. I am just so at home on this site. Monday Mar; 29th I will call my doctor and see if he will help with getting my insurance to pay for the Iressa pill.

Bless You All and again Thanks so much for your help and offers.

Grompy One Lung

Link to comment
Share on other sites

All the advice about communicating with the insurance company, the pre-certification company (if you have one) , the prescribing Dr. and even the manufacturer of Iressa is good advice. It is an approved drug and should be covered either as RX or under major medical by your insurance.

I contacted all the above for help as well as the following drug company helpline. They made calls and were helpful. For information about health coverage, AstraZeneca (the maker of IRESSA) has created the Cancer Support Network. All you need to do is call the toll-free number, 1-866-99-AZCSN (1-866-992-9276), to speak to someone who can help you. Your nurse or doctor can also call this number to discuss health coverage issues.

I also contacted Walgreen's Pharmacy Corporate Headquarters, Special Rx since my Rx was being treated as a reimbursement and I was looking at the prospects of shelling out almost $2000 per month up front for these pills. Walgreens contacted my insurance company and worked out a deal so they'd fill the Rx, bill the insurance co. directly. What a relief! Walgreen's # 888-782-8443 option 1, x3748 Tracy.

I started a triple threat regime of carbo, taxol + Iressa on 3/3/04 as prescribed by Dr. V. Miller at Memorial Sloan-Kettering who will be presenting his findings in May of improved responses with the addition of Iressa for those who have "never" smoked. In spite of other findings and even the Iressa web info., this information seems to be gaining acceptance for making Iressa a first line companion drug.

Scans in a few weeks to see what's going on.

Good luck.

Link to comment
Share on other sites

Hi All of You Wonderful Folks

My doctor called me today and told me I could go pick up my Iressa pills anytime and that all was approved. So I went and got them tonight, will start taking them Monday morning. Or, my last good weekend, LOL...

Thanks so much for all of the good thoughts and Help in this.

Bless You ALL.

Grumpy One Lung

Link to comment
Share on other sites

Join the conversation

You can post now and register later. If you have an account, sign in now to post with your account.

Guest
Reply to this topic...

×   Pasted as rich text.   Restore formatting

  Only 75 emoji are allowed.

×   Your link has been automatically embedded.   Display as a link instead

×   Your previous content has been restored.   Clear editor

×   You cannot paste images directly. Upload or insert images from URL.

×
×
  • Create New...

Important Information

By using this site, you agree to our Terms of Use.