Herceptin Ins Coverage

ferretmom

My onc wants me to do 30 weekly infusions of Herceptin and Zometa every 6 months. Only other drugs are Arimidex daily.

 My co-pay for the Herceptin alone is around $2600 per treatment. Not possible for us.

I have been in contact with a couple of organizations that might help with the co-pay, but even this leaves a huge amount my responsibility. I see many ladies on Herceptin. How does your ins handle it?

Drug?

Medical treatment?

orange1

Most of us have yearly out of pocket maximums.  Once we hit that payment, everything else is free for the remaining of the calendar year.  Check with your insurance, maybe you have one too.

Genentech has a program where they reduce the price of Herceptin for low income patients.  Check out their website.

I am wondering why your onc is not giving you chemo.  I looked at your earlier posting on your pathology - typically women get full chemo for Her2+ and a 13mm ILC.  Herceptin has been shown to be more effective with chemo.

lovemygarden

Tell your oncologist to apply to Genetech's "Patient Access Program" on your behalf. It is designed for situations like yours and also for uninsured patients like myself. But it must go through your oncologist, because Genentech requires a copy of your medical file(s).

Btw, it is not for "low income" patients only; the maximum-total-household-income threshold for Herceptin applications under Patient Access is $100,000/year. Hardly low-income. 

If your onc won't apply for this for you, find another onc...... Seriously.

ferretmom

Thank you ladies for the suggestions.

My Onc has refered me to the Patient Access through Genetech. I'm in the process of completing paperwork now.

As for why no chemo for me, the onc spent much time going over the different protocols with me.

Since the Mx took care of the cancers in the breast, the concerns now are the pNO i+ nodes and Her-2 3+.

I will take Aromasin for the ER+ PR+

He feels the Herceptin, along with Zometa will be as benificial for me as adding the more toxic chemo drugs.

AmyIsStrong

Most insurance policies have an 'out of pocket max' for the year - i.e. the most you can pay before they pay 100%.  I had a large deductible and then paid 20% until I reached the out of pocket max, but after that, insurance paid everything.  Please be sure you understand your policy completely.

 Also, I had some trouble re my insurance company reimbursing at an acceptable rate for the Herceptin and had some scary moments but finally got it worked out.

I hope this works out for you.