Topic: AETNA TX denies life extending drugs to MBC patient

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Posted on: Aug 7, 2017 08:02PM

Posted on: Aug 7, 2017 08:02PM

MaineRottweilers wrote:

I cannot be the only person in the USA dealing with this situation. Aetna TX is a HUGE company with many subscribers. On July 26th, I received two letters of denial, one for Herceptin and one for Perjeta. As of July 1st, these pharmaceuticals (as well a Kadcyla and host of other HER2 targeted therapies) were dropped from my plan's formulary.

I am in the process of an appeal but a decision will not be made before my next infusion. I have applied to Genentech for financial aid, I have written my US Senators and Congressmen as well as my State Rep, the Attorney General of Maine and the Governor. My cancer center is working on an appeal as well. They have never had anyone denied access to Herceptin or Perjeta and were absolutely perplexed by the situation.

Aetna is denying standard of care, life extending therapies. Therapies that studies show not only increase progression free survival time but lengthen overall survival times. Aetna is thus, knowingly, shortening the lives of patients with HER2+++ metastatic breast cancer.

Have you been affected? What are you doing? More voices = more power. Contact me.

Tracy Arcari

MaineRottweilers@twc.com

Tracy Arcari Dx 5/1/2013, DCIS, Left, 4cm, Stage 0, Grade 3, 1/4 nodes, ER+/PR-, HER2- Dx 5/1/2013, IDC, Left, 3cm, Stage IIB, Grade 3, 1/4 nodes, ER-/PR-, HER2+, Surgery 5/14/2013 Lymph node removal: Left, Sentinel; Mastectomy: Left Targeted Therapy 6/14/2013 Herceptin (trastuzumab) Chemotherapy 6/14/2013 Carboplatin (Paraplatin), Taxotere (docetaxel) Radiation Therapy 10/1/2013 External: Lymph nodes, Chest wall Surgery 8/28/2014 Prophylactic mastectomy: Right Dx 10/8/2015, IDC, Stage IV, Grade 3, ER-/PR+, HER2+, Surgery 10/19/2015 Chemotherapy 10/22/2015 Taxotere (docetaxel) Targeted Therapy 10/23/2015 Herceptin (trastuzumab) Targeted Therapy 10/23/2015 Perjeta (pertuzumab) Radiation Therapy 11/9/2015 External: Bone Chemotherapy 1/7/2016 Taxol (paclitaxel) Hormonal Therapy 4/1/2016 Arimidex (anastrozole)
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Aug 8, 2017 10:18AM cive wrote:

Are you sure this isn't just a coding error?  More than once something has been denied because it wasn't coded right when billed.  The ACA is still applicable although the insurance companies don't know if or when they'll be paid.

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Aug 8, 2017 12:59PM MaineRottweilers wrote:

I am certain. It was a change in the formulary associated with my plan. A coding error would be AWESOME. I have spent hours on the phone with Aetna. My MO is eyebrow deep in the appeal process, this is not a coding error.

Tracy Arcari Dx 5/1/2013, DCIS, Left, 4cm, Stage 0, Grade 3, 1/4 nodes, ER+/PR-, HER2- Dx 5/1/2013, IDC, Left, 3cm, Stage IIB, Grade 3, 1/4 nodes, ER-/PR-, HER2+, Surgery 5/14/2013 Lymph node removal: Left, Sentinel; Mastectomy: Left Targeted Therapy 6/14/2013 Herceptin (trastuzumab) Chemotherapy 6/14/2013 Carboplatin (Paraplatin), Taxotere (docetaxel) Radiation Therapy 10/1/2013 External: Lymph nodes, Chest wall Surgery 8/28/2014 Prophylactic mastectomy: Right Dx 10/8/2015, IDC, Stage IV, Grade 3, ER-/PR+, HER2+, Surgery 10/19/2015 Chemotherapy 10/22/2015 Taxotere (docetaxel) Targeted Therapy 10/23/2015 Herceptin (trastuzumab) Targeted Therapy 10/23/2015 Perjeta (pertuzumab) Radiation Therapy 11/9/2015 External: Bone Chemotherapy 1/7/2016 Taxol (paclitaxel) Hormonal Therapy 4/1/2016 Arimidex (anastrozole)
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Aug 8, 2017 02:33PM ShetlandPony wrote:

Yes. When my insurance was switched to a different company in January, I was shocked to discover that Femara/letrozole and Arimidex/anastrozole were not on the formulary. How ludicrous. There is no alternative medication as these are the only two non-steroidal aromatase inhibitors. As it happened, I needed to change my meds just at that time, so I did not have to enter into battle like you, Maine. I'll be following to see what happens. This looks like the latest insurance company ploy to deny care -- just take treatments off the formulary. Is there a state insurance commissioner for you to contact as well? I'm sorry you have to fight for treatment in the midst of all the other things we patients face. Thank you on behalf of all of us.

2011 Stage I ITCs sn, premenopausal, Oncotype 16. 2014 Stage IV mets breast,liver. TaxolNEAD. Ibrance+letrozole 2yrs. Fas+afinitor nope. XelodaNEAD 2yrs. Eribulin,Doxil nope. SUMMIT FaslodexHerceptinNeratinib for Her2mut NEAD 1 1/2yrs. GI/perit mets Dx 2011, ILC, 1cm, Stage IA, Grade 1, 0/1 nodes, ER+/PR+, HER2- Dx 2014, ILC, 2cm, Stage IV, metastasized to liver/other, Grade 2, ER+/PR+, HER2- Hormonal Therapy Tamoxifen pills (Nolvadex, Apo-Tamox, Tamofen, Tamone) Radiation Therapy Whole breast: Breast Surgery Lumpectomy
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Aug 8, 2017 02:46PM - edited Aug 8, 2017 02:52PM by bareclaws

Maine, this is terrifying.. I'm with a different Texas insurance provider for Medicare Supplement and I'm now afraid of a domino effect. If the situation isn't quickly resolved I hope you take it public and scream loudly! The lives of many women are hanging in the balance,

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Aug 8, 2017 03:27PM MaineRottweilers wrote:

You bet, I will be the squeaky wheel. This must be my purpose. Uhg, Lord, please couldn't my purpose have been brownie batter tester? ;)

Really, this could be a disaster for cancer patients of all types if these exclusions are allowed to go on unchecked. Fingers crossed that we get some attention and new regulations are developed. The stress is unimaginable. I looked at my denial, plan didn't pay just over $18K, that's $18K every three weeks that I have to figure out how to raise. No patient should have to fight for care, they are already fighting for life. I will do whatever I can to ensure no one else has to go through this. I just want to eat brownie batter now-----stress.

They picked the wrong battle.

Tracy Arcari Dx 5/1/2013, DCIS, Left, 4cm, Stage 0, Grade 3, 1/4 nodes, ER+/PR-, HER2- Dx 5/1/2013, IDC, Left, 3cm, Stage IIB, Grade 3, 1/4 nodes, ER-/PR-, HER2+, Surgery 5/14/2013 Lymph node removal: Left, Sentinel; Mastectomy: Left Targeted Therapy 6/14/2013 Herceptin (trastuzumab) Chemotherapy 6/14/2013 Carboplatin (Paraplatin), Taxotere (docetaxel) Radiation Therapy 10/1/2013 External: Lymph nodes, Chest wall Surgery 8/28/2014 Prophylactic mastectomy: Right Dx 10/8/2015, IDC, Stage IV, Grade 3, ER-/PR+, HER2+, Surgery 10/19/2015 Chemotherapy 10/22/2015 Taxotere (docetaxel) Targeted Therapy 10/23/2015 Herceptin (trastuzumab) Targeted Therapy 10/23/2015 Perjeta (pertuzumab) Radiation Therapy 11/9/2015 External: Bone Chemotherapy 1/7/2016 Taxol (paclitaxel) Hormonal Therapy 4/1/2016 Arimidex (anastrozole)

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