Does Insurance approve Ibrance for pre-menopausal women

adymaria
adymaria Member Posts: 37
edited June 2018 in Stage IV/Metastatic Breast Cancer ONLY

Hi all,

Today I received a letter from CVS caremark informing me that my Dr's request for Ibrance was denied since I'm not "postmenopausal". The exact words were "Standard Ibrance Policy does not allow coverage of Ibrance when it is taken with an aromatase inhibitor for breast cancer if the patient is not postmenopausal". However, my doctor's plan was to force me into menopause by taking a monthly Zoladex shot. My first shot was this Tuesday. My first thought was, well maybe CVS caremark isn't aware that I'm taking a zoladex shot for ovarian suppression. But then I realized they had approved the zoladex the day before the ibrance denial, so maybe they did know about the zoladex and still denied me for Ibrance since I'm technically not of postmenopausal age. Is there anyone in my situation (who wasn't technically "postmenopausal" but was forced into menopause) and who has been approved for Ibrance? I won't be able to talk to my doctor about this until Monday. Would be nice to know if someone in my situation had the Ibrance/Femara combo approved by insurance, so I'm not thinking about it all weekend.

Thanks




· Share on FacebookShare on Twitter

Comments

  • Piggy99
    Piggy99 Member Posts: 229
    edited June 2018

    I got approved for Ibrance even though I had to take it with Tamoxifen for two months, until my blood tests showed that the Lupron shots were working and I was in induced menopause. I then switched to Letrozole. Some insurance providers might be less accommodating and make you wait a couple of months until you are actually in induced menopause, but I think most women in the US generally get approved.


    · Share on FacebookShare on Twitter
  • adymaria
    adymaria Member Posts: 37
    edited June 2018

    Good to know, thank you for the response. Your diagnosis is very similar to mine. Are you doing treatment before surgery like myself, to decrease the size of the tumor before surgery? If so, how is the ibrance/femara combo working for you? Can you tell if it's shrinking the tumor? My doctor said it would be obvious.

    · Share on FacebookShare on Twitter
  • pajim
    pajim Member Posts: 2,785
    edited June 2018

    adykort, my guess is that the two requests went to different offices and the left hand didn't know that you were going to have ovarian suppression. Wait a month (after the first Zoladex shot) and apply again.

    Yes you need to be 'post-menopausal' but Zoladex qualifies you for that.

    · Share on FacebookShare on Twitter
  • Piggy99
    Piggy99 Member Posts: 229
    edited June 2018

    Adykort, my medical team doesn't recommend surgery for metastatic patients, so I'm on Ibrance/letrozole to keep the cancer under control and hopefully even beat it back some. I've had good results so far, after the first three months the bone mets and lymph nodes were almost gone by PET/CT and the breast only showed physiological uptake (so no FDG-avid tumor). The doctor can still feel a "thickening" in the breast (which can be scar tissue or sleeping cancer that's not metabolically active enough to be seen by PET), but it's changed quite dramatically from a hard tumor that was over 5cm in January.

    · Share on FacebookShare on Twitter
  • finallyoverit
    finallyoverit Member Posts: 382
    edited June 2018

    I am pre-menopausal and on Ibrance and Femara. I’m still trying to recover mentally and physically from a spinal fusion, so for now, monthly Lupron shots make me post until I have surgery. I’m in no hurry. I also don’t get my Ibrance from CVS, it come so from a specialty pharmacy

    · Share on FacebookShare on Twitter

Categories