A Little Help Please!

My wife was diagnosed with stage IIIB lung cancer. She is 44 years old and has never smoked. We can't figure that one out.

Her doctor has started her on Tarceva. It is considered a second line option to the insurance company. Our doctor indicated that it has been very effective in first line treatment. My wife has the non small cell type of cancer.

Here is my problem. We have Blue Cross of Georgia and they suck! They have refused to pay for the drug. I have already purchased the first 30 pills. The drug Tarceva costs 4300.00 for 30 pills. The drug company will give us the drugs for free however we exceed the income level.

Blue Cross has made decision on how to treat my wife out of the doctors hands. We have been denied two times. The first by a clerk at Blue Cross and second when our doctor did a peer to peer. What is sad during the peer to peer Blue Cross had a regular MD on th other end of the phone. It seems like they just go thru a flow chart and make decisions. What is sad is other insurance company's have approved the use of Tarceva for first line.

I can pay for the Tarceva for a short time but it will begin effect my family and my business long term.

If anyone has ideas please let me know.

Thanks in advance.

Our next steps that are in process are as follows:

Demand an a outside board of review with a oncologist sitting on the board.

I have hired an attorney that deals with the health insurance company's.

Thanks for listining. Hopefully I posted in the corrrect place.

Hi Stan,

I'm sorry to hear about your wife.  I also have lung cancer, stage 4, and am currently on tarceva 150.  It is a great drug and minimal side effects once you get past the first few months.

Have you looked into clinical trials.  They would provide the meds free of charge if  you can get in one.  Dana Farber Cancer Institute is currently recruiting for women with adenocarcinoma for a tarceva trial (NCT00137839).  There are several others out there also.

www.clinicaltrials.gov  and search on tarceva

I have been on it for going on 22 months now and have a very good quality of life.  It is worth fighting to get it. 

Hi,

I also have NSC lung cancer - stage IV - also have never smoked so I understand what a shock it is.  I was diagnosed about a year ago - I did take Tarceva as a first line treatment although it was on a clinical trial; one arm received just Tarceva and the other arm had standard chemo of carboplatin and taxol plus Tarceva.  The Tarceva was supplied by the trial. I know there are other trials looking at Tarceva as a first line drug - I agree with Chessie that you might want to check into that.

Has you wife's tumor been tested for the EGFR mutation?  From what I understand, if that mutation is presesnt, the Tarceva should work and the insurance may approve coverage.  According the the studies that have already been done, Tarceva as a lirst line treatment didn't make a difference in the survival rate for lung cancer as a whole but it did give a survival advantage for certain groups - people who haven't smoked is one group.  That's why they are doing more studies using Tarceva as first line treatment in those groups.   Right now the FDA has only approved Tarceva for second line treatment - I'm sure that has a lot to do with your insurance company's decision.  Using it as a first line treatment is considered off label and would be defined as experimental under many insurance plans.

Continue with the appeal process with your insurance - having a specialy review should help.   I hope it does work for your wife - it is a much easier treatment than chemo.  I've had some side effects but on the whole I've had a good quality of life.

Good luck! 

Petunia55

Tarceva is still in clinical trials, have you looked into that?  If she could qualify for a clinical trial it would be paid for.

 You can look on the internet for Tarceva clinical trials.

??

Look on the internet.  I saw Tarceva for $3,200 for 100 pills (which would be $32 per day.

Can't remember the site though.