As you begin treatment with Hycamtin, it is important to understand the extent of your insurance coverage. Your doctor’s office will work closely with your payer (i.e., your insurance company, HMO, Medicare, or Medicaid office) to determine what expenses are covered and what information is required. You can prepare by asking yourself the following questions:
Is my policy currently in effect?
Does my policy cover cancer treatment?
Does my policy have a preexisting condition clause?
Is chemotherapy covered in an outpatient setting (doctor’s office, hospital outpatient, clinic, etc.)?
Is prior approval or preauthorization required?
Is the physician “participating,” “approved,” or “in network”?
Is Hycamtin covered by my policy?
What can I do to protect my current insurance coverage?
What is “open enrollment”?
Am I eligible for Medicare?
Am I eligible for Medicaid?
Are there laws that affect my insurance coverage?
Are there other resources to help with the cost of Hycamtin?
To help you understand the terms and phrases you’ll encounter in your insurance research, we’ve gathered some of them here in a helpful glossary.
Is my policy currently in effect?
If you have paid your premiums, your policy should be in effect. Your cancelled checks are your best records for any policies you arranged for. If you’re covered by an employer’s coverage, the benefits manager should be able to answer your questions.
Does my policy cover cancer treatment?
Some policies have exclusions where they specifically state they will not cover certain illnesses.
top
Does my policy have a preexisting condition clause?
If your cancer was diagnosed before your policy became effective, this may be considered a preexisting condition. Some plans deny coverage for an illness that was previously diagnosed. Other plans deny coverage for a predetermined length of time (usually 6 months or 1 year) and may even require that an individual be “treatment free” during the waiting period to qualify for coverage. During a preexisting condition waiting period, your insurance company may not pay for any care you receive related to your cancer. As a result of a law passed in 1996, any preexisting condition exclusion period must be reduced by the period of time the individual has maintained health insurance coverage, without a break of 63 consecutive days or more immediately before enrolling in the new health insurance. This could mean immediate coverage and payment for your treatment.
top
Is chemotherapy covered in an outpatient setting (doctor’s office, hospital outpatient, clinic, etc.)?
Most plans cover chemotherapy provided in an outpatient setting. Private insurance plans (for example, Aetna, Blue Cross and Blue Shield) generally cover chemotherapy under a major medical benefit. In addition to chemotherapy, major medical benefits usually include coverage for doctor’s services, diagnostic tests, laboratory services, etc. Medicare covers chemotherapy under its Part B program. Part B also covers doctor’s services, diagnostic tests, durable medical equipment, ambulance services, and other health services and supplies not covered under the Medicare Part A program. State Medicaid programs usually cover chemotherapy under the doctor or pharmacy program.
Is prior approval or preauthorization required?
Some plans, especially health maintenance organizations (HMOs) or preferred provider organizations (PPOs), require the doctor to ask permission before starting treatment.
top
Is the physician “participating,” “approved,” or “in network”?
Some plans, especially HMOs and PPOs, either require you to receive care from a doctor who has signed a contract with the payer, or make you pay more money for using a doctor who is not in the plan. Let’s say, for example, your doctor participates in your insurer’s PPO. The insurance pays 80% and you are responsible for paying the remaining 20%. However, if you are treated by a doctor who is not a participating provider, your payer may cover less than 80%—probably closer to 60%. That would mean you would be responsible for paying the remaining 40% of the bill.
top
Is Hycamtin covered by my policy?
In order for payers to make reimbursement decisions about any specific therapy, they may want to know more about it. For example, they may ask the following:
- Has the drug been approved by the FDA?
Yes, Hycamtin has been approved by the FDA for the treatment of metastatic carcinoma of the ovary after failure of initial or subsequent chemotherapy. Hycamtin has also been approved by the FDA for the treatment of small cell lung cancer sensitive disease after failure of first-line chemotherapy. Sensitive disease is defined as disease responding to chemotherapy but subsequently worsening at least 60 days after chemotherapy. Hycamtin in combination with cisplatin is indicated for the treatment of histologically confirmed Stage IV-B, recurrent, or persistent carcinoma of the cervix which is not amenable to curative treatment with surgery and/or radiation therapy.
- What is the billing code for Hycamtin?
Most insurance companies require doctors to use special billing codes when they submit an insurance claim for medical products or procedures. These codes tell things like the patient’s diagnosis and what services were provided. Payers can then use this information to confirm that the service is the right thing to do for the illness. The billing code for Hycamtin is J9350.
For help understanding your insurance plan and/or to resolve billing issues regarding Hycamtin, contact the GlaxoSmithKline Oncology REIMBURSEMENT HELPline™. The people who will help you are experienced when it comes to working with insurance claims and resolving insurance issues. And they will help you or your doctor at no charge. In some situations the REIMBURSEMENT HELPline™ staff may suggest that you contact your employer to seek their intervention with your insurance company. Reimbursement specialists are there to help you Monday through Friday, between 9:00 AM and 8:00 PM (EST). The toll-free number is: 1-800-699-3806.
REIMBURSEMENT HELPline™ is a trademark of Parexel.
top
What can I do to protect my current insurance coverage?
- Plan ahead. Know your policy. Be alert to coverage and benefit limitations, so you can make plans. When you are 18 to 24 months from termination or exhaustion of benefits, begin looking for new insurance or making arrangements for new coverage
- Educate yourself. Study your policy and learn insurance terms so you can speak knowledgeably to the payer about your needs. If you cannot understand your policy or just don’t have time to read it, you can send it to the REIMBURSEMENT HELPline™. The experts there will read it for you and help you understand it
REIMBURSEMENT HELPline™
1-800-699-3806, M–F, 9:00 am to 8:00 pm EST
- Be aware. Know what expenses are charged to your plan and ultimately to you. The explanation of benefits (EOB) or remittance advice received from your payer details submitted charges and the amount allowed and paid
- Join a support group. Having other people to talk to who are facing similar problems and issues, and sharing information, is extremely helpful. Strength grows from numbers. Speak with your doctor and other providers about such programs. Also, contact the American Cancer Society at 1-800-ACS-2345 or The Wellness Community at 1-888-793-WELL
top
What is “open enrollment”?
Many states offer an open enrollment period, which lets people considered high risk or those with preexisting conditions buy individual health insurance policies. Contact your state Department of Insurance or the REIMBURSEMENT HELPline™ for more information.
REIMBURSEMENT HELPline™
1-800-699-3806, M–F, 9:00 am to 8:00 pm EST.
top
Am I eligible for Medicare?
Medicare is a federally funded program designed mostly for the aged and permanently disabled. You may be eligible for Medicare if you are over 65, or under 65 and with one or more of the following:
- Social Security disability, and have been receiving Social Security income for 24 months
- Railroad retirement disability benefits
- End-stage renal disease benefits
Medicare Supplemental Plans
Medicare Supplemental Plans, called Medigap, are offered by private insurance companies, not the federal government. These plans help patients with medical expenses not covered by Medicare. For example, they will pay the remaining 20% after Medicare pays 80% for such services as chemotherapy provided in an outpatient setting. Contact a private insurance company (for example, Blue Cross or Blue Shield) or the REIMBURSEMENT HELPline™ for more information on Medigap plans.
REIMBURSEMENT HELPline™
1-800-699-3806, M–F, 9:00 am to 8:00 pm EST.
top
Am I eligible for Medicaid?
Medicaid is a state medical assistance program. Each state has its own rules on who will get help, but usually only financially needy persons without any other type of insurance are eligible. Contact your state Department of Public Welfare or Department of Social Services for more information.
top
Are there laws that affect my insurance coverage?
Consolidated Omnibus Budget Reconciliation Act (COBRA).
COBRA is a federal law that requires employers of 20 or more people to offer a temporary extension of health coverage if a person:
- Works fewer hours
- Loses his/her job (for any reason other than gross misconduct)
- Gets divorced from, or becomes legally separated from, a partner who has the medical insurance, or if the partner with the insurance dies
- Becomes eligible for Medicare benefits
- Loses dependent child status under an existing policy
COBRA can extend the benefits for 18 to 29 months, depending on the situation. The employer is required to notify the worker of the availability of this benefit. If you need more information, contact the personnel or insurance department at your company, or the Department of Labor COBRA hotline at (202) 219-8776, or the REIMBURSEMENT HELPline™ 1-800-699-3806, M–F, 9:00 am to 8:00 pm EST.
The Health Insurance Portability and
Accountability Act (HIPAA)
This measure addresses such issues as waiting periods between jobs, coverage for small companies, and coverage for the self-employed. A person changing jobs may be denied coverage under an employer’s health plan for an existing health problem for up to a one-year waiting period. Under the new law, however, any preexisting condition exclusion period must be reduced by the period of time the individual has maintained health insurance coverage without a break of 63 consecutive days or more immediately before enrolling in the new health insurance. In other words, if you worked at the XYZ Company for five years and had medical insurance all that time, the new insurance plan cannot make you wait a year before your insurance kicks in. The law also prohibits group health plans from denying coverage or charging extra to cover an individual due to an existing medical problem. And finally, the law requires insurers to offer health insurance coverage to qualifying people who were covered under a group plan before and are now seeking insurance as self-employed individuals.
State coverage for cancer drugs
Some states have passed laws requiring private insurance companies to reimburse for cancer drugs when the medical literature shows they are safe and effective. For example, ABC drug might be FDA approved for treating lung cancer, but scientists have shown that it is also good for treating liver cancer, so many doctors use ABC to treat liver cancer. Please contact the REIMBURSEMENT HELPline™ to confirm the status of your state.
REIMBURSEMENT HELPline™
1-800-699-3806, M–F, 9:00 am to 8:00 pm EST.
Rules applicable to Medicare HMOs
If you receive Medicare benefits through a Medicare HMO, your HMO has to follow the rules and procedures set down by the Department of Health and Human Services. Like any insurance program, these rules cover issues like how much will be paid for office visits, drugs, medical procedures, therapy, and so on. Your Medicare HMO is required to notify you any time they will be denying your coverage. They have to tell you if:
- Your treatment will not be paid for
- Your treatment will be only partially paid for
- They will not provide a particular treatment
- They will be providing less treatment, or
- They will not treat you any more
They also have to give you written information on your rights to an appeal and how to go about it, including any deadlines you may have to meet when you have to provide documentation.
top
Are there other resources to help with the cost of Hycamtin?
Change your existing policy
If you had coverage under your employer, you may never have considered being added to your spouse’s policy, or vice versa. You may now want to consider this if it will expand your coverage or protect you from possible loss of coverage due to maximum benefits.
Convert your policy
Some group plans allow conversion of the policy, which means while you have exhausted your benefits through the group plan, you can purchase individual coverage under the same group plan by paying the premium for your policy. This may be a good strategy, and can be explored with your benefits manager. The premiums may be high, and the benefits may not be as complete as those of the group. Evaluate the cost of the premium versus the benefits, especially the lifetime maximum.
Relocate or change employment
While it may be difficult to think about moving your family, you may find that more favorable insurance coverage is offered in another state. For example, you may not be able to purchase a policy from Blue Cross/Blue Shield in your state, but in another state Blue Cross/Blue Shield may offer guaranteed acceptance with a high lifetime maximum benefit. Changing jobs may be risky because of loss of coverage. However, if you intend to look for new employment, question employers about health insurance benefits and coverage for preexisting conditions. The insurance coverage offered by a new employer may be more comprehensive or may allow you to start over with a new lifetime maximum allowance. This is particularly true if you move from a small employer to a large one. If you are required to join a trade union in connection with your job, and your insurance is available through a union trust, you may want to discuss a higher lifetime maximum benefit with your coworkers and union steward as an additional benefit to address when contracts are considered for renegotiation.
Become a member of an organization offering a group policy
Many fraternal and professional groups (for example, Rotary Club and the Chamber of Commerce) make large group coverage available. You may find that clubs or special interest organizations to which you already belong offer coverage. Examine the benefits and lifetime maximum. While premiums may be reasonable, the benefits and lifetime maximum may be low or restricted.
State assistance programs
In addition to Medicaid, many states have other medical benefit programs for people in need. These are fully state funded and vary by state. You can investigate them by calling the State Health Department.
Contact compassionate organizations
Nonprofit organizations and local fundraisers are formed to address individual or group health needs. The dollars raised may be given to a health care provider for a particular patient’s medical bills that cannot be paid because of lack of insurance, or may be used to pay insurance premiums for people who cannot otherwise afford to do so. Some of these programs may have waiting lists or requirements that prevent immediate sign-up. So, if you think you need help now or will need it soon, look into these options now. Don’t wait. Click for a list of Support Groups.
GlaxoSmithKline Oncology Commitment to Access Program
Commitment to Access is one of three GlaxoSmithKline patient assistance programs that provide free products to eligible patients. GSK oncology products, including Hycamtin, are available free of charge through Commitment to Access for eligible low-income patients without prescription drug benefits.
Please visit the Commitment to Access Web site at http://www.commitmenttoaccess.gsk.com, or call 1-8-ONCOLOGY-1 (1-866-265-6491) to obtain additional information.
Remember, no one source can answer all your questions or replace the information provided by your doctors and nurses. This Web site is not intended to replace ongoing communication between you and your health care team.
top
Important Safety Information
Use of Hycamtin
Hycamtin is used for the treatment of recurrent ovarian cancer.
Hycamtin is used for the treatment of small cell lung cancer that returns at least 2 months after completion of your first treatment.
Hycamtin plus cisplatin is used for the treatment of cervical cancer, if it is widespread when first diagnosed, doesn’t go away with your first series of treatments, or comes back in a form that can’t be cured with surgery or radiation.
Reasons Not to Use Hycamtin
Do not use if you have had an allergic reaction to Hycamtin, if you are pregnant, if you are breast-feeding, or if you have low blood counts.
Side Effects
Hycamtin can interfere with your body’s ability to make white and red blood cells. Your doctor may prescribe a supportive therapy to help your body make more blood cells.
Side effects often associated with Hycamtin when used alone included nausea (64%), vomiting (45%), diarrhea (32%), hair loss (49%), fatigue (29%), and shortness of breath (22%). Most of these side effects were mild to moderate.
Side effects often associated with Hycamtin plus cisplatin when used to treat cervical cancer included low blood counts, pain (22%), vomiting (15%), nausea (14%), other digestive problems (14%), abnormal laboratory tests that may or may not cause symptoms (14%), and bladder/pelvic problems (12%).
|
|
