Enhertu insurance claim

[bc_metastasis]

Hi,

Had anyone successful in claiming insurance for Enhertu which got introduced in India recently in January 2024 ?

[Band123]

I will be trying in next month...will keep you posted.!Had your Insurance company paid claims for tdm-1.!!?

[bc_metastasis in reply to Band123]

Hi,

Yes my corporate insurance paid for 8 out of 9 TDM-1 cycles and rejected one quoting “sublimit exceeded for immunotherapy”.

I'm following up with them to clarify TDM-1 is chemotherapy and not immunotherapy

[balakrishnaga in reply to Band123]

Hi ,

Is there any patience assistance program running for Enhertu in India ?

[bc_metastasis in reply to balakrishnaga]

As of today, no patient assistance program is available for Enhertu.

[balakrishnaga in reply to bc_metastasis]

Ok thank you

[bc_metastasis in reply to Band123]

Hi,

Please share your experience if you already tried insurance claim. Thanks

[Band123 in reply to bc_metastasis]

No..We haven't tried Enhertu yet.

[Srikalakm in reply to Band123]

Hi was Enhertu approved by your insurance team ?

[Band123 in reply to Srikalakm]

No..We haven't tried Enhertu yet.

[Srikalakm in reply to Band123]

Hi did you try perjeta + herceptin did it get approved ?

[Band123 in reply to Srikalakm]

Yeah we have tried perjeta and herceptin ,but they got approved only partially as my corporate insurance policy has limit on monoclonal antibody(Immuno therapy).Expecting tdm-1, Enhertu to be paid as chemotherapy drugs...tdm-1 got paid initially and declined later, I am still in process of discussing with the New India Insurance company General Manager.

[Srikalakm in reply to Band123]

Because our doctor is ready to give certificate to tell perjeta and herceptin are targeted not immunotherapy and mine is corporate insurance. Will they accept this and approve?

Like we have new india insurance with mediassist as Tpa

[Band123 in reply to Srikalakm]

You may try, but ,It actually depends on your Insurance policy coverage .

[bc_metastasis in reply to Srikalakm]

Yes, they approved for Enhertu partially applying sub-limit under immunotherapy