Is Trastuzumab Emtansine/Kadcyla/Ujvira alone covered under Insurance in India

[bga1]

Hi my mother was diagnosed with triple positive breast cancer in 2019 and now it metastases to brain.

Doctor advised for Trastuzumab Emtansine/Kadcyla/Ujvira , wanted to know does it cover under Insurance in india.

Earlier when she was under Trastuzumab only for a year and Insurance was denied.

[Nikita1806]

Hey .. i am on the same boat as you.

We are planning to start with kadcyla.. do you know about any patient programs?

Also my oncologist said he dont have much idea about ujvira?

What your oncologist opinion?

[bga1 in reply to Nikita1806]

Hi .. I told my oncologist that insurance company is not approving Trastuzumab so he suggested ujvira which is cheaper and an alternate drug for kadcyla.

[Nikita1806 in reply to bga1]

Hi just wanted to let you know i was able to do a cashless kadcyla infusion. Everything got approved and we didn’t pay for the first infusion.

[bga1 in reply to Nikita1806]

That's great .. wanted to know whether u have corporate insurance or personal. I have a corporate insurance with The New India Assurance.

[Nikita1806 in reply to bga1]

Yes its a corporate insurance. Care insurance relgare.

[Mohit91 in reply to bga1]

Hey I’m facing the same issue. The tpa for new india assurance declined my cashless request stating some sublimit on immunotherapy. They authorised partial bill amount for the first cycle and declined for the subsequent claim. I just wanted to know weather you got the claim or you are facing the same problem as well. I was going to take up the legal recourse for the claim.

And if you can enroll the patient in BLUE TREE cancer assistance program.

[bga1 in reply to Mohit91]

Hi Mohit ,

I faced same issue with Trastuzumab where initially they approved claims and later rejected saying its not part of policy. So decided to go with Ujvira which is bio similar of Kadcyla and cost is less compared to Kadcyla. For my mom 2nd infusion of Ujvira is done and insurance is approved for both.

[Mohit91]

Hey bga1

We have started with kadcyla and she will be receiving her third done on 7th of march . I read about ujvira after getting first infusion so I decided to continue with kadcyla only. I’m in process of filling a suit against the insurer and TPA. And if they approved your ujvira infusion they can’t legally deny you for kadcyla because its a biosimilar and the reason they stated while rejecting my claim was a sublimit on immunotherapy and since both the drugs are biosimilars they can not pick and choose.

And can you please share your contact info

[bga1 in reply to Mohit91]

Hi Mohit ,

As you mentioned claim is rejected due to sublimit on immunotherapy .. it could be valid because cost of Ujvira 160mg is 50K but where as Kadcyla is 2.5 lakh , so for 1 dose of Kadcyla you could get 5 doses of Ujvira. This Saturday my mom will be receiving her 3rd infusion and update you once its done. Please contact me on [e-mail]

[ellaarkay in reply to Mohit91]

Hi Mohit, i do have the same issue with United insurance denying Ujvira after 3cycles on ground that it's mca. I disputed arguing that it's antibody drug conjugate mandated by NCCN. Will go to Ombudsman first. Please let me know the results of case if u have filed any. Thanks

Radhakrishnan

[prabhu_111 in reply to ellaarkay]

Hi did you get any information..even our claim is rejected..my moms 3rd infusion is pending

[ellaarkay in reply to prabhu_111]

Hi Ihave taken it up thro our office. Awaiting revert.txs

[rajasivaji in reply to ellaarkay]

any update, please

[Band123 in reply to ellaarkay]

Hi, Any update this?? please. My claim got rejected stating it is a monoclonal antibody.

[rajasivaji]

I have a corporate insurance and getting approval for last 2 years, suddenly got denial citing sublimit. Any update on this.

[ellaarkay]

I am preparing to knock at the door of ombudsman. Can someone guide me on this?

[Band123]

Hi,

Can all please share their experiences on getting claims denied for TDM-1/Ujvira/Kadycla

I have Corporate insurance with New India Assurance,and they have declined claims stating that TDM-1 is considered as Monoclonal body only.

[Band123]

Did anyone get a approval for tdm-1 after initial rejection?