Problems with Insurance and Femara

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AnacortesGirl
AnacortesGirl Member Posts: 1,758
edited June 2014 in Stage III Breast Cancer

Just talked to my mom last night.  She got a letter from Aetna stating that after May 1 they would no longer provide payment for Femara.  She'll be responsible for the total cost.  I'm not sure how much that is because she threw away the information sheet from her last refill.  She just told me it's "expensive". 

Is anyone else having problems like this?  What's the deal, anyway?  I thought insurance companies would want to pay for preventive medicine.  Would they rather she had a recurrence and pay for that treatment??

BTW - in addition to medicare my parents have Aetna from their Boeing retirement.

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  • carol1949
    carol1949 Member Posts: 562
    edited March 2010

    There are all kinds of programs to get that drug for free, if not reduced price.  It is expensive... about $400. per month.  If she really wants to take it, she can get it through one of many programs.  She may have to ask her Dr. to help or contact the drug company directly.

    Personally, I chose Not to take it due to the many bad s/e's.  I take Lugol's iodine.... about 6 drops per day which basically does the same thing.... it negates estrogen in the breast, has no side effects and costs me about $60. per year !!!

    p.s.  As for insurance companies....there are many different programs within each company.... so the same thing could have happened w/ BCBS or any of them!

    Moral of the story is look into some alternatives!

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  • NatsFan
    NatsFan Member Posts: 3,745
    edited March 2010

    Have your mom contact her oncologist right away to let them know of this situation.  There are other aromatase inhibitor drugs that your mom may be able to use that might be covered by Aetna.  Or if the onc feels that your mom really needs to be on Femara, they can help you with the appeal process. 

    Femara is pricey - as Carol says, Femara costs about $400 for a 30 day supply.

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  • AnacortesGirl
    AnacortesGirl Member Posts: 1,758
    edited March 2010

    I'll pass on the info to my mom about checking with the company for programs that may cover the cost.  And the appeal process. 

    She hasn't seen her onc yet -- she just had her last visit with her surgeon and mentioned it to him.  He didn't have any solid leads but did mention that it may be possible to get out of Canada.  He also said something about contacting Susan G. Komem to see if they could put some pressure on Aetna but I don't know if that would get anywhere.

    She tried Arimidex but the muscle pains combined with her arithritis was enough that she said she wouldn't take it anymore.  And I really want her to be around.  She's been wonderful support for me as I've gone through my tx.

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  • AnacortesGirl
    AnacortesGirl Member Posts: 1,758
    edited March 2010

    Onc's office is trying to work with Aetna and get them to cover the cost.  That's looking promising at this point.

    My DD also ran across a program from Novartis where they will assist with covering the cost of the prescription.  If you pay more than $10 for a 30 day supply they will cover the additional cost up to $800.  Works with private insurance or no insurance.  If you go to their site you can find a sidebar link to the following:

    http://www.drtms.net/NVSFemara/FemaraPOD/default.aspx

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  • apple
    apple Member Posts: 7,799
    edited March 2010

    oh oh.

    actually, she should talk to her insurance agent is she has one.  I've found Aetna to be extremely accomodating and their customer service excellent..   I'm going to have to give them a call.  She might not have a pharmacy benefit?

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  • AnacortesGirl
    AnacortesGirl Member Posts: 1,758
    edited March 2010

    Apple -

    She does have a pharmacy benefit.  Three tiered, progressive costs.  The benefit had been covering Femara but the letter she got a couple weeks ago says that Femara will no longer be in the tiered plan as of May 1.  But the onc's nurse called Aetna and they claimed it would be covered.  Rather confusing.

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