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Triple negative breast cancer using Prolia
I am triple negative breast cancer with bilat. mastectomies and bilat ovaries removed. I have been on Prolia for almost 12 years but my new insurance denied Prolia as I wasnt on a antihormone medication (like letrozole or anastrozole) to prevent hormone + breast cancer which FDA states is required. I cannot seem to work around it at this time. I am postmenopausal in my 70's so I really do not have a high risk for hormone + breast cancer at anytime and dont need the drug to prevent it. Has anyone else had this issue and if yes, how were you able to resume Prolia?
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This makes no sense to me, why would they require you to be on an anti cancer drug to treat your bones? Ugh, sometimes I really hate insurance companies. If you have osteopenia or osteoporosis this feels a no brainer, but again……ugh, we are talking about insurance companies. You might need to talk your doctor about what drug he recommends you use for bone health and then enlist their help with fighting for it.
Have you had a recent dexa scan to determine where your bone health sits?
Sometimes I find talking to the insurance directly helps. Have you called the insurance company directly and asked for them to approve this drug for your bone health? What was the answer?
The first time talking to the insurance company they were not very helpful. I called again and was told the prior off form as my diagnosis of breast cancer with osteoporosis and suggested the doctor sends a new prior authorization to just say osteoporosis. If the new insurance company denies it again then I have to do an appeal. I am keeping my fingers crossed as I'm sure it was the wrong box checked on the prior authorization form and it will work itself out. Insurance companies and doctors both drive me crazy!
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1 ReactionThis does sound like a wrong box was checked. Any update, @paulyd1?