How Do I Get Insurance to Pay for Tarceva?

Tarceva is the brand name for a drug called Erlotinib, a tyrosine kinase inhibitor used to treat certain kinds of lung cancer. It is commonly used in the United States and is not considered an experimental treatment. Most medical insurance plans that cover prescription drugs will cover Tarceva. If you do not already have medical insurance, chances are, you will not be able to get individual health insurance if you are already undergoing cancer treatment. You must then pay for Tarceva out of your own pocket, enroll in a group health insurance plan or get your state's Medicaid plan to pay for the drug.

Instructions

• 1

  Enroll in a group insurance plan if you're not already covered for prescription drugs like Tarceva. If you are able to work, you may be able to enroll in a group plan through an employer that offers health insurance as an employee benefit. Group plans are not medically underwritten: Insurance carriers must accept all employees who are qualified for coverage, regardless of their medical history or condition. You may have to wait 90 days before you can claim benefits, however.

• 2

  Appeal your insurance plan's decision not to cover Tarceva, if necessary. If you are already covered by a health insurance plan and the carrier has refused to cover the drug, you may be able to appeal. Look at your insurance policy to see if the drug has been excluded. If your plan covers prescription drugs and does not exclude Tarceva, get supporting documentation from your doctor that says Tarceva is part of a medically necessary course of treatment. Send this letter to your insurance company, following the appeal procedures outlined in your plan. If this fails, you can appeal to your state's department of insurance regulation.

• 3

  Enroll in Medicaid, if necessary, to pay for Tarceva. To be eligible for Medicaid, a social welfare program that provides medical coverage for the poor, you may have to get your assets below your state's eligibility guidelines. Even then, Medicaid may not cover you unless your income is also below its guidelines. Each state has different regulations and eligibility criteria, and different states also allow for different exemptions from the Medicare asset eligibility guidelines. For example, a certain amount of home equity is often exempted. Check with your state's department of health and human services for specifics.