› Forums › General Melanoma Community › First Choice: Zelboraf denied by insurance company
- This topic has 24 replies, 5 voices, and was last updated 12 years, 8 months ago by
awillett1991.
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- February 10, 2013 at 9:26 pm
Briefly, my husband was diagnosed Stage IV on January 18, 2013. He has had 11 rounds of radiation to his pelvic area for two large masses and a tumor at L1 causing significant pain (1 to go!). He also had cyberknife this past Friday morning for a tumor in his parietal lobe. The plan was to start Zelboraf this coming Wednesday, Feb 13, at Dana Farber. I believe the Zelboraf appears to be a sound, valid first choice of treatment, since Don did test positive for the BRAF mutation.
Briefly, my husband was diagnosed Stage IV on January 18, 2013. He has had 11 rounds of radiation to his pelvic area for two large masses and a tumor at L1 causing significant pain (1 to go!). He also had cyberknife this past Friday morning for a tumor in his parietal lobe. The plan was to start Zelboraf this coming Wednesday, Feb 13, at Dana Farber. I believe the Zelboraf appears to be a sound, valid first choice of treatment, since Don did test positive for the BRAF mutation.
Insurance company says he was 600R instead of 600E and is therefore ineligible. Has anyone else had this experience? We have appealed the decision, and the DFCI doctor has sent supporting documentation that the 600R is clinically identical to the 600E.
Don't these insurance companies know they are dealing with peoples' lives here?
Help?
Janet
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- February 10, 2013 at 10:53 pm
Janet,I am BRAF 600D. I have been on and off since Apr 2010 and it has saved my life. Keep pushing. I bet DF will get it through. You can msg me if I can be of further help.
This might be useful:
http://www.biomedcentral.com/content/pdf/1471-2407-13-17.pdf-Amy
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- February 10, 2013 at 10:53 pm
Janet,I am BRAF 600D. I have been on and off since Apr 2010 and it has saved my life. Keep pushing. I bet DF will get it through. You can msg me if I can be of further help.
This might be useful:
http://www.biomedcentral.com/content/pdf/1471-2407-13-17.pdf-Amy
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- February 10, 2013 at 10:53 pm
Janet,I am BRAF 600D. I have been on and off since Apr 2010 and it has saved my life. Keep pushing. I bet DF will get it through. You can msg me if I can be of further help.
This might be useful:
http://www.biomedcentral.com/content/pdf/1471-2407-13-17.pdf-Amy
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- February 11, 2013 at 12:06 am
Janet, I received my January Zelbarof for $100 using the card provided below.
If the link doesn’t work, just google Genentech Zelbarof access solutions. I didn’t go through my insurance at all due to some miscommunication with the ins. co. In Dec. I had received it through my ins co’s specialty pharmacy. This card works, do not take no for an answer. If need be, ask Genentech for assistance finding a pharmacy that will accept the card. It worked very easily for me–they ask you 3 or 4 questions and give you a printable card until yours comes in the mail.
I believe all pharmacy options will be mail-order specialty pharmacies and mine gives free overnight delivery. The first customer-service rep I spoke with didn’t know what to do, but the pharmacist sure did.http://www.genentech-access.com/zelboraf/hcp
Hope this helps,
Karen
Sorry you didn’t know her, but as our beloved Boots would say: Don’t give up–Don’t back down! -
- February 11, 2013 at 12:06 am
Janet, I received my January Zelbarof for $100 using the card provided below.
If the link doesn’t work, just google Genentech Zelbarof access solutions. I didn’t go through my insurance at all due to some miscommunication with the ins. co. In Dec. I had received it through my ins co’s specialty pharmacy. This card works, do not take no for an answer. If need be, ask Genentech for assistance finding a pharmacy that will accept the card. It worked very easily for me–they ask you 3 or 4 questions and give you a printable card until yours comes in the mail.
I believe all pharmacy options will be mail-order specialty pharmacies and mine gives free overnight delivery. The first customer-service rep I spoke with didn’t know what to do, but the pharmacist sure did.http://www.genentech-access.com/zelboraf/hcp
Hope this helps,
Karen
Sorry you didn’t know her, but as our beloved Boots would say: Don’t give up–Don’t back down! -
- February 11, 2013 at 12:06 am
Janet, I received my January Zelbarof for $100 using the card provided below.
If the link doesn’t work, just google Genentech Zelbarof access solutions. I didn’t go through my insurance at all due to some miscommunication with the ins. co. In Dec. I had received it through my ins co’s specialty pharmacy. This card works, do not take no for an answer. If need be, ask Genentech for assistance finding a pharmacy that will accept the card. It worked very easily for me–they ask you 3 or 4 questions and give you a printable card until yours comes in the mail.
I believe all pharmacy options will be mail-order specialty pharmacies and mine gives free overnight delivery. The first customer-service rep I spoke with didn’t know what to do, but the pharmacist sure did.http://www.genentech-access.com/zelboraf/hcp
Hope this helps,
Karen
Sorry you didn’t know her, but as our beloved Boots would say: Don’t give up–Don’t back down! -
- February 11, 2013 at 12:07 am
Note that the article recommended by Amy was investigating Dabrafenib, not Zelboraf (vemurafenib). However, the authors refer readers to references #5-7 that supposedly demonstrate that vemurafenib works on V600D mutations. You might want to check out those references.
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- February 11, 2013 at 12:07 am
Note that the article recommended by Amy was investigating Dabrafenib, not Zelboraf (vemurafenib). However, the authors refer readers to references #5-7 that supposedly demonstrate that vemurafenib works on V600D mutations. You might want to check out those references.
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- February 11, 2013 at 12:07 am
Note that the article recommended by Amy was investigating Dabrafenib, not Zelboraf (vemurafenib). However, the authors refer readers to references #5-7 that supposedly demonstrate that vemurafenib works on V600D mutations. You might want to check out those references.
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- February 12, 2013 at 3:33 am
Janet, I meant what I wrote about reading my email to them. Appeal the first three people who tell you no, and get it in writing so your onc can contradict it.
I have heard about the 5 weeks in hell from IPI, but for a 1 in 4 chance of killing Don’s Mel I would sure consider it. Keep fighting for tumor targeting and be on the lookout for a contingent fee lawyer.
Keep us up with what happens. Get your doctor to put it inwriting that BRAF positive, no matter the address indicates that it would be efficacious.
John -
- February 12, 2013 at 3:33 am
Janet, I meant what I wrote about reading my email to them. Appeal the first three people who tell you no, and get it in writing so your onc can contradict it.
I have heard about the 5 weeks in hell from IPI, but for a 1 in 4 chance of killing Don’s Mel I would sure consider it. Keep fighting for tumor targeting and be on the lookout for a contingent fee lawyer.
Keep us up with what happens. Get your doctor to put it inwriting that BRAF positive, no matter the address indicates that it would be efficacious.
John -
- February 12, 2013 at 3:33 am
Janet, I meant what I wrote about reading my email to them. Appeal the first three people who tell you no, and get it in writing so your onc can contradict it.
I have heard about the 5 weeks in hell from IPI, but for a 1 in 4 chance of killing Don’s Mel I would sure consider it. Keep fighting for tumor targeting and be on the lookout for a contingent fee lawyer.
Keep us up with what happens. Get your doctor to put it inwriting that BRAF positive, no matter the address indicates that it would be efficacious.
John-
- February 12, 2013 at 1:54 pm
Wow John, your advice sounds terrific. Thank you for paying it forward. Janet, if your hubby has commercial insurance (not Medicare)
he should be able to get the Zelboraf Genentech access card. When I get to work, I’ll post the exact name. All I had to do was answer 2 or 3 questions; did I have commercial insurance, and was my income below a certain level, maybe $100,000. I would try to get the card then get the Zel ASAP while you duke it out w/the insurance co.
Also, as someone else mentioned, DF should be VERY experienced with this. Be persistent and don’t worry about “bothering” whomever you’re calling; this is their job!
Keep us posted,
Karen -
- February 12, 2013 at 1:54 pm
Wow John, your advice sounds terrific. Thank you for paying it forward. Janet, if your hubby has commercial insurance (not Medicare)
he should be able to get the Zelboraf Genentech access card. When I get to work, I’ll post the exact name. All I had to do was answer 2 or 3 questions; did I have commercial insurance, and was my income below a certain level, maybe $100,000. I would try to get the card then get the Zel ASAP while you duke it out w/the insurance co.
Also, as someone else mentioned, DF should be VERY experienced with this. Be persistent and don’t worry about “bothering” whomever you’re calling; this is their job!
Keep us posted,
Karen -
- February 12, 2013 at 1:54 pm
Wow John, your advice sounds terrific. Thank you for paying it forward. Janet, if your hubby has commercial insurance (not Medicare)
he should be able to get the Zelboraf Genentech access card. When I get to work, I’ll post the exact name. All I had to do was answer 2 or 3 questions; did I have commercial insurance, and was my income below a certain level, maybe $100,000. I would try to get the card then get the Zel ASAP while you duke it out w/the insurance co.
Also, as someone else mentioned, DF should be VERY experienced with this. Be persistent and don’t worry about “bothering” whomever you’re calling; this is their job!
Keep us posted,
Karen
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- March 14, 2013 at 10:35 am
I got an email from Janet last night. Don came through his craniotomy in good shape. His symptoms have improved and he is now in rehab to regain his strength. Equally, important, with the help of our own Tim Turnham and a lot of effort by the staff and Dana Farber, Genentech granted Don compassionate use of Zelboraf and he will be starting that tomorrow. Hooray! Let's hope and pray that Don has a terrific response!
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- March 14, 2013 at 10:35 am
I got an email from Janet last night. Don came through his craniotomy in good shape. His symptoms have improved and he is now in rehab to regain his strength. Equally, important, with the help of our own Tim Turnham and a lot of effort by the staff and Dana Farber, Genentech granted Don compassionate use of Zelboraf and he will be starting that tomorrow. Hooray! Let's hope and pray that Don has a terrific response!
-
- March 14, 2013 at 10:35 am
I got an email from Janet last night. Don came through his craniotomy in good shape. His symptoms have improved and he is now in rehab to regain his strength. Equally, important, with the help of our own Tim Turnham and a lot of effort by the staff and Dana Farber, Genentech granted Don compassionate use of Zelboraf and he will be starting that tomorrow. Hooray! Let's hope and pray that Don has a terrific response!
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