BCBS Prior Authorization Denial for a Chemotherapy Drug Yondelis
I'm currently receiving oncologic care at the #1 cancer hospital MD Anderson for leiomyosarcoma (rare/aggressive soft tissue sarcoma). My doctor has recommended systemic chemotherapy with doxorubicin in combination with trabectedin (Yondelis). My insurance has denied the Trabectedin on the basis that the regimen is not FDA-approved for this specific adjuvant indication and is considered off-label or investigational under the plan’s policy. There is literature supporting of using leiomyosarcoma to support this combination chemotherapy.
I have been denied by a self-funded plan BCBS of Texas. Ironically, I am an employee of the university of Texas the same university system as MD Anderson, on a plan for that university, seeking treatment at one of their hospitals.
I tried filing a complaint with my state's commissioner, but couldn't because it is a self-funded plan. I applied for the Johnson & Johnson patient assistance program for the drug Yondelis, but was denied because I don't meet income guidelines for the drug (60k for 2 people).
Does anyone have any recommendations on how to get the insurance decision overturned?