insurance companies pay for medications when a drug has received fda approval for treatment or there are advanced clinical trials (phase iii and above) which show that the treatment is effective. what is hard for patients and families to sometimes understand is that insurance companies only pay for proven therapies not experimental therapies. this is especially hard when the disease is cancer. fortunately the national institute of health and drug manufacturers are very involved in clinical trials for new cancer drugs or new indications for cancer drugs. clinical trials are very important because cancer drugs are generally very toxic and expensive and we need scientific evidence to decide on the best treatment options not anecdotal successes. because each cancer patient’s situation is different we want to make sure that a drug works for a particular patient. not all breast cancer patients are the same. some have limited disease some have advanced disease some breast cancers occur before menopause some after and hormonal and genetic characteristics can vary from patient to patient. afinitor (everolimus) is fda approved for breast cancer in combination with aromasin (exemestane) for certain postmenopausal women. the breast cancer must be advanced hormone-receptor positive her2-negative and in patients who experienced a recurrence or progression of their cancer after treatment with hormone therapy using femara (letrozole) or arimidex (anastrozole). if your sister fits in this category then her cancer doctor can write a letter to the insurance company citing her qualifications. another important avenue to pursue for cancer patients is clinical trials. you can look up clinical trials on the web site <link> by cancer type and features in your zip code or state. there are several ongoing breast cancer trials using everolimus (afinitor) that may be applicable to your sister. talk with her cancer doctor about clinical trials and assistance in working with the insurance company to get the best treatment for your sister.
how can i convince the medical insurer to pay for newly on-the-market drugs (re cancer patient stage 4)? . my sister has metastasized breast cancer. afinitor appears to be the drug treatment option with the most hope. how can i convince the medical insurer to ok (and pay for) this drug treatment? what are the most likely to succeed methods to put the pressure on them for the purpose of extending my sister's life with these new medical treatments?