Hi all....I pray blessings on you, and your families in the midst of fighting PC and
the Covid Virus.....Rob recently received notice from Express Scripts that his
oncologist
's renewal of his Estradiol Patch was denied by Medicare.....the Express scripts representative explained that it is because the patch is not approved for the treatment of PC....Rob was placed on this med in May of 2015 by Dr. Meyers and has been on it ever since. Have any of you experienced a denial for the Estradiaol Patch by Medicare recently....if so, have you been successful in appealing it? Thank you for any help/info you can provide. Take good care all.
Written by
4luvofrob
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I assume this is low-dose E2 to help mitigate side effects of ADT.
Not sure if this would work to get coverage, but it needs to made clear that in this case the patch is not a treatment FOR the PC itself, but is a treatment for side effects of ADT. In other words, it should be claimed as being used to treat a disease OTHER than PC that has resulted as a byproduct of PC and/or its treatment.
So if there is evidence of a decline in bone mineral density, then could the doc say it is being prescribed to treat osteoporosis, which I assume is an ON-label use of the patch? That is the angle I would take: see what the approved uses are and then find one that can be claimed by your doc.
The only time patches are used DIRECTLY to treat PC is in higher doses, and that use is NOT approved in the US by the FDA as withing the SOC, so far as I know. If it was, I would be doing it now!
Regarding DES, it would be important to restrict it to a LOW dose, because as the dose rises over, say, 1 mg, then so do risks:
"Compared to estradiol, DES has greatly improved bioavailability when taken by mouth, is more resistant to metabolism, and shows relatively increased effects in certain parts of the body like the liver. These differences result in DES having an increased risk of blood clots, cardiovascular issues, and certain other adverse effects."
"A 3 mg/day dosage of DES has been associated with an incidence of cardiovascular complications of 33.3%. A lower dosage of 1 mg/day DES has been associated with a rate of death due to cardiovascular events of 14.8% (relative to 8.3% for orchiectomy alone)."
[Which isn't a huge increase, to my mind.]
In addition to patches, there are also gels and creams that can be applied to the skin, which will probably be preferable to oral dosing (even if a bit more expensive).
This is probably not the right way to do this....so I hope that all of you who have responded to my question about the Estradiol Patch see it and know how very much I appreciate your responses....I continue to be amazed by how caring and gracious....and knowledgeable.... so many on this are.....Thank you and Blessings on each of you!!!
......It seems that the availability of DES Is getting very difficult these days. I went to 3 compounding pharmacies and they all stated their inability to get it.....if anyone is still obtaining it please share
I was able to get a script for DES. None of the local compounding pharmacies had it (their supplier can't get hold of it), but I went online & found a pharmacy in NJ that has it. <$50 for a 3 month supply of 2mg caps.
The risk of clots is very low with oral 1mg DES, which is what one should take initially (I seem to need a bit more than 1mg.) But one should also take nattokinase too, IMO. Monitor D-dimer.
Transdermal estradiol is inexpensive as Tall_Allen as indicated. There are a couple of different forms of this, some of which are covered by insurance/MC and others not. I prescribe this fairly routinely for my clients both for ADT symptom control and/or as an alternative to lupron in some situations. Several of our clients are former Snuffy patients since he retired. Let us know if we can be of assistance 480-881-5621. drfabio.com
My urologist uses code C61, prostate cancer for estradiol patch scripts. I use three .1 mg patches by Sandoz weekly. I’ve never had trouble getting scripts approved by Medicare part D .
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