Topic: Getting Avastin

Many of you are trying to get Avastin added to your chemo regimen.  Some seem to be able to do this without much incident.  Others have had to move mountains. 

I want to post a helpful email that came to me from a Dr. that has been extremely helpful to us, it was meant specifically for this purpose.  If anyone else is having good experiences getting their insurance to cover medications, please share so that we know all know the correct strategies to get this done.  This is one stress that no one should have to deal with during this kind of a battle.

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I am very sorry to hear that your insurance company has denied your physician's request to incorporate Avastin into your treatment regimen. I would advise that you take the following steps;

1. Contact other patients and ask them if their Oncologists can provide you with letters detailing their objective findings with respect to adding avastin in their treatment of advanced intrahepatic cholangiocarcinoma. You need to obtain documentation from them detailing a positive response (i.e., stabilization and/or further shrinkage of the tumor once avastin was added to the treatment regimen).

2. Search NIH.gov for current clinical trials with avastin against biliary and gallbladder cancers. Obtain from this search the names of physicians conducting such trials and ask them if they can provide you with a letter supporting your request.

3. Determine from your physician if a pathology specimen of your tumor was assessed by immunohistochemistry for VEGF expression. If the Pathologist associated with your case can provide documentation that your tumor is positive for VEGF, you can better justify the need to add avastin to your treatment regimen.

Also determine in advance if your insurance company will accept such data as justification for covering the cost of avastin treatments..

4. Make the insurance company aware that avastin has been demonstrated to produce positive results when combined with conventional chemotherapy in the treatment of human metastatic colorectal and pancreatic ductal adenocarcinomas. Pancreatic ductal adenocarcinoma shares a number of pathological and molecular alterations that are also found in cholangiocarcinoma. In addition, they should be made aware of the fact that VEGF expression has been demonstrated in human cholangiocarcinomas, and most importantly, based on current experiences, that clinical trials with avastin have now been expanded to include such cancers as breast, prostate, lung, renal, esophageal-gastric, and hepatocellular carcinoma. Thus, it is very reasonable for your physician to want to include this targeted drug therapy as part of your treatment.

I hope this information is useful to you.

Re: Getting Avastin

thanks alot stacie - very helpful, we are going for a second opinion on weds, i wanted to discuss avastin with the oncologist..you've posted this at just the right time!

jules

Re: Getting Avastin

I'm wondering if anyone else out there has AETNA.  So far, these people have been a nightmare.  It has added greatly to the stress for my husband and I.  They refuse to pay for the tests for his tumor markers.  They refuse to pay for a visit to a Dr. and University of Colorado where we consulted about therasphere treatement which I'm sure means they will refuse the treatment as well.  Is it just us?  Does anyone have anything positive to say about AETNA?  If so, I'd like to hear it because I'm so so so discouraged.  When I get something in the mail from them, I just cringe.  If you're looking for health care provider I would recommend United Health Care.  They were wonderful.

Re: Getting Avastin

Hi, this is Annie at Caruso149caruso. We were just denied Avastin by Aetna. First because Duke didn't write in the correct code. then they said it wasn't indicated for my husband's type of cancer. We have had Aetna for 15 years and had not had a problem. Now they see what the bills are going to be. Not only are they denieing Avastin but they have just denied speech therapy for our son which they have been paying since last September. I don't understand.