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Posted 6/16/2014 8:16 PM (GMT 0)
Did anyone have trouble with their insurance company filling or paying for Zytiga. I have Express scripts as a pharmacy insurance and they are making it hard on Dr. ,Nurse ,Me. It is almost like they are throwing up as many road blocks as possible to ever get the Med. Please tell me how you got around all this stuff they are throwing up to get our med.
Posted 6/16/2014 8:57 PM (GMT 0)
My husband also has Express scripts. He has not had a problem at all with getting Zytiga.

I'm thinking it might have more to do with his company's policy, rather than their provider, Express scripts.
Posted 6/16/2014 9:42 PM (GMT 0)
Thanks. They want a "pre-approval". Did you have to do this?
Posted 6/16/2014 11:59 PM (GMT 0)
I also have Express scripts and my Mayo Oncologist had to get prior approval before they would fill the the Rx.
Posted 6/17/2014 12:21 AM (GMT 0)
Thanks. What was your CO pay on what I understand is a $9000 a month med.
Posted 6/17/2014 1:52 AM (GMT 0)
My co pay is $13.00 for a 90 day supply of Zytiga.
Posted 6/17/2014 3:10 AM (GMT 0)
Was just reading our company formulary and shockingly Zytiga is on there but firmagon isn't covered... I don't see docetaxel on this list either but supposedly they are putting Paul on it..... IDK....

We really wanted firmagon instead of Lupron/casodex....

Paul's brother died at 50 from heart attack, his dad had strokes and heart attack in mid 50s (led to his death) as well as all his uncles, and what we have read about Lupron makes firmagon seem like a better choice given the family history....

Anyhow I was shocked Zytiga was on there...

I hope you get this sorted soon!
Posted 6/21/2014 12:36 AM (GMT 0)
I just got the pre-approval from Humana.

Not only that after taking to Dioplomat Pharmacy who is doing thd fulfillment, theri financial assitance make it sound like there are foundations that will fund it for us since our combines income for a fmaily of 2 is less than $60K.

Most of my assets are in indexed annuitites that they do not take into consideration, jsut the retirement and IRA payouts I receive each month.

I have not started the mandatory 10% that has to be taken anytine between age 59.5 andf 70.5, so they do not factor that in either, just my monthly Social Security and IRA's in payout mode.

LupronJim
Posted 6/22/2014 12:34 PM (GMT 0)
Good for you. I am still having trouble with Express scripts. You might look at Zytiga website. My copay was about $ 200 but Zytiga has a program where your copay is $10. It is under the financial support tab on the web site.
Posted 6/22/2014 3:09 PM (GMT 0)
We were able to get 100% coverage through the Patient Access Foundation. (Our Cancer Center did the legwork to get it after Social Security never got back to us for support).

Susan
Posted 6/22/2014 5:16 PM (GMT 0)

radsgrrl22 said...
We were able to get 100% coverage through the Patient Access Foundation. (Our Cancer Center did the legwork to get it after Social Security never got back to us for support).

Susan

Ditto, I am not sure of the Foundation name yet but all the financial assitance paperwork was done over the phone with Diplomat Pharmacy who is providing the Zytiga/Prednisone.

To not dely the intial drug, I paid the $2,650 or so copay but foundation will reimburse pe Diplomat financial assitance team.

LupronJim
Posted 7/1/2014 4:40 PM (GMT 0)
No Zytiga! MDAnderson ordered Zitiga and Pred.. Repeat MDAnderson Oncologist ordered it. GEHA ,my Gov. insurance Co.," ask eviti ,Inc. an independent third party expert cancer decision support company to review
the medical cancer treatment plan." long story/ short. It was denied. "Falls under the definition of experimental/investigation medicine."

Took me 4 days driving and a lot of money to go to Houston's MDAnderson for nothing. I really do not know what to think.
What should I do? live with the decision or go to veterans admin. and try to get it? Or appeal their decision. Lots to think about and any advice is appreciated.

Post Edited (deros) : 7/1/2014 10:48:07 AM (GMT-6)

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