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What are the chances of prostate cancer recurrence?

Prostate Cancer | Last Active: Apr 20 8:51am | Replies (13)
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@jeffmarc

Where do you live (country)? There’s a lot of controversy about whether or not insurance will pay for a second treatment of Pluvicto. I know that it is done in Australia, Did you have any issues getting insurance to pay for it? In the USA it is questionable whether insurance will pay for it.

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Replies to "Where do you live (country)? There’s a lot of controversy about whether or not insurance will..."
lag | @lag | Apr 19 11:44am

I believe smc24 has posted about this issue before. He is in the US. His first Pluvicto treatments were as part of a clinical trial, so neither he nor insurance paid for them.. That is how and why his second round of Pluvicto is being covered--because it counts as his first round in the eyes of Medicare and insurance companies.

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smc24 | @smc24 | Apr 19 1:16pm

To jeffMar:
My situation is very unique. I received the first round of 6 Pluvicto treatments as a Norvartis Pharmaceutical clinical trial patient in 2021-22. As the prostate cancer returned in early 2024, my oncologist, Medicare and my supplemental insurer conferred. Since Norvartis paid the cost the first go around, the insurers see the 2nd set of treatments as their first, and agreed to pay for this now, US FDA program.
You are correct in saying the insurer only pays once.

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