Patients Concerned as Humana Takes Herceptin Off Preferred Drug List in South Florida

Brielle Urciuoli

Patients and advocates alike took to social media after the insurance company Humana took Herceptin (trastuzumab) off its list of preferred drugs for patients in Florida.

Until recently, Herceptin, which is used to treat patients with metastatic breast cancer, was fully covered under Humana’s South Florida Medicare Advantage plans. But, after taking it off the preferred drug list, patients will now be responsible for 20 percent of the drug’s cost, better aligning South Florida’s plans with Humana’s other Medicare Advantage plans.

“For the 2018 calendar year, Humana chose to make our coverage of Herceptin in South Florida consistent with the coverage provided by all other Humana Medicare Advantage plans, and more closely aligned with most plans offered by our competitors and the Original Medicare program,” Roy Beveridge, M.D., Chief Medical Officer of Humana, said in a statement.

“As a result, all Humana Medicare Advantage members, including those in South Florida, will pay 20 percent cost sharing for Herceptin in 2018. The intent of our coverage change for 2018 was to align our coverage in South Florida with our other Medicare Advantage plans, our competitors and the Original Medicare program.”

Patients, survivors and advocates around the nation are not taking the change lightly.

One CURE Contributor, Martha Carlson, who was diagnosed with metastatic breast cancer in 2015, wrote that she was lucky to have good coverage, but at the end of the day, is still at the mercy of her insurer. After seeing Herceptin move off of the preferred list in South Florida, she is worried that this may spark a chain reaction for other markets and insurance companies, too.

“The even worse part of Humana's decision with Herceptin is that there is no guarantee this cost-saving move by one company in one market will be the only such action,” she wrote in a Jan. 19 blog post. “How soon is it before Herceptin is no longer on my preferred list? How soon before every one of us will have to shoulder costs that put standard care out of reach, despite insurance?”

Carlson also mentioned Ogivri, a biosimilar for Herceptin. The drug was approved in December 2017 for patients with HER2-positive breast cancer and metastatic gastric or gastroesophageal junction adenocarcinoma – the same indications for Herceptin.

While this drug may end up driving costs down for patients with metastatic breast cancer, it may be a while before they get it. Despite its approval, the drug likely won’t become commercially available until 2019.

“But it is January 2018 and even one year of Herceptin co-payments could be enough to drive people to forgo treatment with this standard-of-care drug or continue its use and endanger the financial security of themselves and their families,” Carlson said.

But folks at Humana don’t want patients to give up hope. In the statement, Beveridge reminded readers that the South Florida Medicare Advantage Plans have a yearly $3,400 out-of-pocket maximum. The cost of Herceptin will go toward that max, and after patients reach that mark, their treatments are fully covered for the rest of the year.

“Humana is committed to helping our members receive affordable access to the treatments they need and, as appropriate, will help identify external programs available to help offset the costs of Herceptin and other high-cost medications,” Beveridge said. “We will also continue to work with patients, physicians and other stakeholders to identify and advance public policies that address the rising prices of prescription drugs.”

Herceptin is currently approved as an adjuvant treatment for patients with HER2-positive breast cancer, as a firstline treatment for patients with HER2-positive metastatic breast cancer and for patients with metastatic, HER2-positive gastric cancer.
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