AETNA TX denies life extending drugs to MBC patient

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MaineRottweilers
MaineRottweilers Member Posts: 156
edited August 2017 in Employment, Insurance, and Other Financial Issues

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

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  • cive
    cive Member Posts: 709
    edited August 2017

    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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  • MaineRottweilers
    MaineRottweilers Member Posts: 156
    edited August 2017

    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.

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  • ShetlandPony
    ShetlandPony Member Posts: 4,924
    edited August 2017

    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.

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  • bareclaws
    bareclaws Member Posts: 345
    edited August 2017

    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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  • MaineRottweilers
    MaineRottweilers Member Posts: 156
    edited August 2017

    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.

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