Anyone have zanubrutinib/Brukinsa denied?

Posted by newwaldenguy @newwaldenguy, Feb 3 11:19pm

I am currently covered with an employer plan. I am considering retiring prior to 65 which means my options are cobra for a short time then ACA/marketplace prior to 65 and getting Medicare, either Advantage/part C or medigap/part G.

Has anyone ever had zanubrutinib/Brukinsa denied by insurance for a WM diagnosis? If if so what was the insurance or circumstance?

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suznsl | @suznsl | Feb 6 5:33pm

Hi newwaldenguy. Yes, I recently found I have Waldenstrom and 2 of the 3 doctors I went to for opinions wanted me to start on Zanu/Brukinsa but Highmark denied the request and the appeal. They suggested I go on Calquence. I'm not sure what happened, because I thought Calquence was what I'd be on then, but am going to actually be starting Imbruvica in the next few days. I don't think they're related. But in the past few days I had a lot of dizziness and throwing up so admitted myself to an ER in which they put a catheter in my neck and started some plasmaphoresis, in which I feel so much better. Should be out of the hospital soon. Sorry you're being denied too. I hear good things about Zanu.

newwaldenguy | @newwaldenguy | Feb 8 1:52am

Suznsl. Thanks for the reply. Sorry you had to undergo plasmapheresis but I am glad you are feeling better. Imbruvica, Calquence, Brukinsa are all BTK inhibitors so they are related. Imbruvica is 1st gen, and Calquence and Brukinsa are 2ng gen. I am glad you are getting started on one of them soon. Hopefully one of those targeted therapies will keep your WM in check. Get weel and get home soon

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