u/ceanzhou

hi, my mum (early 60s) was recently diagnosed with stage 4 breast cancer that has metastasised to her bones. no prior diagnosis to this.

for her specific cancer biomarker, she was recommended endocrine therapy and targeted therapy pills.

the problem is these are take home medications which are very expensive monthly and insurance doesn’t cover take home medications under cancer! insurance agent kept telling me they recognise chemo and radio, and it’s their first time hearing a case where standard first line of treatment is only “pills”.
i’ve gotten our doctor to write a formal letter to insurance on why my mum’s cancer requires this treatment instead of chemo/radio but who knows how long it will take for an answer and we have no idea if it’ll be a positive outcome.
has anyone has gone through a similar issue appealing to insurance about this?
appreciate any help i can get. thanks.

my (25f) mum (early 60s) was recently diagnosed with stage 4 breast cancer that has metastasised to her bones. no prior diagnosis to this.

her biomarkers are ++- and she was recommended AI (endocrine therapy) and targeted therapy + bone injections monthly. the problem is they’re very expensive monthly and insurance doesn’t cover take home medications under cancer. it’s horrible! we live in Malaysia. insurance agent kept telling me they recognise chemo and radio, and it’s their first time hearing a case where standard first line of treatment is only “pills”. i’ve gotten our doctor to write a formal letter to insurance on why my mum’s cancer requires this treatment instead of chemo/radio but who knows how long it will take for an answer and hopefully a positive one. so i decided to enroll her in a phase 3 clinical trial where she will be on ribociclib + either letrozole or palazestrant (their study drug), they can only start her randomisation in 3 weeks due to unforeseen delay.

my only worry is if she progresses while on trial and needs to be taken off it, we’d still have to resort to the alternative options and start paying but finances are a worry. just wondering if anyone has gone through a similar issue appealing to insurance about this?