A member of the advanced prostate cancer on-line support group who is the wife of an advanced prostate cancer survivor in New Mexico just informed us that Trailblazer (the MAC that controls New Mexico reimbursements for Medicare and Medicaid) has said they will not pay for her husband to get Provenge. They were also told by their doctor that he can’t get Medicare/Trailblazer to pay for Jevtana even though he meets the FDA approved label for failed chemotherapy.
She posted: “Jevtana for prostate cancer, Medicare doesn’t want to pay for it. We also learned today that Provenge will not be covered by Medicare & we will have to pay cash for it.
Die or use up all your retirement savings.”
She is very upset as these were his last treatment options that have demonstrated any survival advantage.
Both Provenge and Jevtana have been approved by the FDA.
This is outrageous.
Joel T Nowak, M.A., M.S.W.
Sorry to hear that outcome as it is a shame for those who paid into Medicare from day one not to have the full benefit of which it was designed. Federal government squandering the assets as though it is their right. I am on the waiting list for Provenge at Dana Farber while waiting for a decision from a health insurance company. I can only hope it is a positive answer. It will probably get worse when Obamcare kicks in. Funny how politicians who make the rules for us have an alternative for themselves.
I am very sorry to hear this, my husband and I are going thru the same problem. The Cancer Treatment Center of America in Zion,Il will give my husband the Jevtana he needs and qualifies for, but Federal Blue Cross Blue Shield and my Blue Cross blue Shield (yes, we have double coverage) will not cover the cost.(same with the Provenge) I am just sick about this and don’t know who to fight it with. It sounds to me like the people who can afford to spend 80-100k for the treatment will live and the ones that don’t will die. I never thought it would come to this after paying for insurance all these years. Tammy
We have the same problem in Florida. My husband was accepted for Provenge on June 30th, but a few days later, CMS announced it would do a 1-year study. First Coast (the Florida MAC) won’t pay until CMS makes its decision. We offered to pay cash, and Moffitt Cancer Center was supposedly preparing a cost proposal for us, but without even telling us, they decided to remove themselves from being a Provenge provider.
We contacted another Florida provider, but after several weeks of sending records to them, we’re still jumping through administrative hoops there too.
We’ve been advised to do a pre-determination request with United Healthcare (our Medicare secondary), which will take up to 6 weeks. We’re nervous about yet another 6-week delay for that, since my husband’s cancer isn’t being treated any more, having exhausted all other treatment options.
Tammy, in her comment above, mentions denial from two Blue Cross’s. Has anyone heard whether United Healthcare has done a Provenge pre-determination? If so, how did it turn out?
I found out that Fed.BCBS will cover the cabazitaxel (Jevtana),but only if is a second line treatment meaning my husband could have only been treated with Taxotere. My husband failed taxotere and was put on mitozantrone and responded well for a while. Jevtana now is considered a third line treatment and this is where we sit with insurance. I can’t even get a cost on it to see if we can pay ourself. I know they will not cover Provenge. We have a appointment for the VA to see if they will cover it. This cancer was from exposure to Agent Orange so we can only hope they will approve Jevtana. Janet, I wish you the best in getting the Provenge your husband needs.
same problem, Blue Cross, NJ dragging feet, getting worse by the day, denied first request, reviewing second, they are waiting for patient to die so they don’t need to make decision. If you are one day late with their payment they want to drop you
I hope this reaches the right folks. I am about to take my 3rd treatment with Jevtana. About the Medicare rejections: Trailblazer is Blue Cross/Blue Shield….an insurance co. They will ALWAYS reject first. Stall. Whine. But in South Carolina, where the administrator is “Palmetto’ they ARE paying for it. That means Trailblazer doesnt have a leg to stand on. Medicare is a FEDERAL program and eligibility has nothing to do with where you live. Appeal this garbage ! State FACTS ( what is the criteria, how did the patient meet this criteria, etc). And, most important of all, DO NOT GIVE UP.
This is to “txantique” or anyone else who has taken Jevtana. How is the treatment? My husband has been offered Jevtana by his oncologist but we are petrified about the side effects of the treatment. Also, the cost seems so high. They did not tell us that Jevtana cost $10k the Nuelesta cost $10k then there will be cost for the red blood platelets, and the administration of the drugs and the doctors fees etc. My husband’s insurance sucks with only $50k per YEAR pay out. We can’t afford the treatment and the cost of side effects.
Now I am hearing that Medicare is giving everyone a hard time. My husband is only 62 and still working, so it will take us a while to get on any kind of assistance such as Medicare…I understand that my husband has had his two years with an “extended” life and this is the end, but then they should NOT taughnt us with such medical treatments that we can’t afford – or afford to get to in time. This is a tragedy of the human spirit – and does not demonstrate that ALL MEN/WOMEN WERE CREATED EQUAL…this is survival of the richest…
Many of the drug companies have special programs to assist with access to their medications.
TAMMY: My husband has gotten 5 treatments of Jevtana, BCBS of WNY has covered all of it (so far). He is stage 4 Prostate cancer. He also was in viet nam, and was exposed to agent orange. Have you applied for veterans benefits? We have and got accepted immediately. GOOD LUCK TO YOU>