Tarceva and insurance coverage?!!

• By TheHmip
• Posted June 29, 2009 at 5:11 am
• Report post

I also live in so cal....san diego county. My Onc told me that the Insurance Co won't cover Tarceva as a front line....chemo and/or radiation has to be tried first, then Tarceva. My cousin also had NSCLC and was covered under Kaiser. She was on Tarceva after chemo....so I don't know what your Onc is talking about. I might be looking for another ONC at this point. good luck

• Reply

• By shansdaughters
• Posted June 29, 2009 at 9:48 am
• Report post

that info helps alot! We had just gone to him for a 2nd opinion so he is not my moms onc, I just hadn't thought of the question at our initial appt with my moms onc. This info will help when the time comes that she may be a candidate for it!!! That 2nd md seemed a little more doom and gloom than my moms treating onc. Her onc seems to be very positive and makes us feel like we r treating a chronic condition that can be lived with for many years rather than a terminal illness! Thanks again for the info!

• Reply

• By Pat-M
• Posted June 29, 2009 at 11:14 am
• Report post

I'm sorry, but what the doctor told you sounds crazy, unless he has some specific reason for thinking Tarceva won't work for your mom. I'm in Long Beach, CA. My insurance (Cigna) has covered Tarceva and Avastin from day one - no previous chemo or radiation. Since you've already been on chemo, I can't imagine it not being paid for since it is an approved 2nd line treatment. I would definitely think about finding another oncologist who will fight for you.
Since you are in southern california, you might want to contact Rational Therapeutics (562/ 989-6455) and ask for Shari. Tell her your situation - I'm sure they can give you some better answers. They can also pre-test your mom's tumor to determine which chemo will be most effective before she gets any chemo that won't work. Best luck to your mom! Keep pushing for the Tarceva is she is a good candidate, and change oncologist if you have to until you get one that makes sense and you're happy with! Pat

• Reply

• By emtq
• Posted June 29, 2009 at 11:27 am
• Report post

I live in So. Cal and Tarceva is a covered drug under my insurance.
emtq

• Reply

• By emtq
• Posted June 29, 2009 at 11:29 am
• Report post

Before I began Tarceva I called my insurance company and asked if it was covered. I also asked if there was a cap on it. (No cap) I suggest you call your insurance company directly and speak to someone in the benfits department. You will need to go beyond the person who answers the phone.

• Reply

• By sheilake
• Posted June 29, 2009 at 2:17 pm
• Report post

Insurance companies vary about Tarceva coverage. Some just require co-pays but the co-pays are anywhere from $20 to $2500. You'll just have to ask your insurance company. Your Mom has already had chemo so the main requirement is already met. FDA has only approved Tarceva for after chemo has failed. Most insurance companies follow FDA protocol. There are organizations that can help with whatever you need to pay. Email me if this becomes an issue and I'll be glad to share.

Sheila
Sheilake@aol.com

• Reply

• By shansdaughters
• Posted July 1, 2009 at 12:00 am
• Report post

u r all so kind thanks for the info!!!

• Reply

• By sheilake
• Posted July 1, 2009 at 12:47 am
• Report post

P.S. You need to know that some oncologists make up to a million dollars a year off of delivering chemo. They don't make anything on Tarceva. Thus, many aren't incented to learn much about it. It's a systems problem. You might try Rationale Therapeutics in Long Beach, Ca. as Pat-M suggested. Dr. Nagourney is a great believer in Tarceva and/or chemo -whichever will work best.

Sheila

• Reply

• By ReginaVidaver
• Posted July 1, 2009 at 12:56 pm
• Report post

If you have any troubles with insurance coverage for Tarceva, please contact Genentech's Access to Care Foundation: http://www.gene.com/gene/about/community/access.html
1 (800) 530-3083
They have trained staff on hand to help you!!

Best,
Regina Vidaver, Ph.D.
Executive Director
National Lung Cancer Partnership

• Reply

• By BeBeReader
• Posted July 1, 2009 at 5:49 pm
• Report post

My husband has been on Tarceva for 4.5 years. He received it off-label, which means that he received it with chemo as a first-line treatment. It has always been covered by insurance. We live on the East Coast, but it sounds crazy that the West should not cover this medication.

• Reply

Add to the discussion