Download Lynparza for women with a BRCA mutation and recurrent ovarian

Sample Appeal Letter for Lynparza
in Women with Ovarian Cancer
HEALTH INSURER
123 Insurance Way
Anywhere, IL 012345
DATE
RE:
Insured:
Claimant:
Claim # XXXXXXXXXXX
NAME (ID# XXXXXXXXXXX)
NAME (DOB Mo-Day-Year)
To Whom It May Concern:
I am writing to appeal the decision to deny coverage of Lynparza for treatment of my ovarian cancer by
[Health Plan Name]. Genetic testing confirmed that I carry a germline BRCA genetic mutation which put
me at significantly increased risk of ovarian cancer. In December 2014, the FDA approved olaparib
(brand name: Lynparza) for treatment of patients with deleterious or suspected deleterious germline
BRCA mutated advanced ovarian cancer who have been treated with three or more prior lines of
chemotherapy. [Exhibit A] Lynparza has also been approved by the European Commission and the
National Institute for Health and Care Excellence (NICE) for those with high grade serous epithelial
ovarian, fallopian tube, or primary peritoneal cancer.
The National Comprehensive Cancer Network (NCCN) Guidelines Version2.2015 for Epithelial Ovarian
Cancer/Fallopian Tube Cancer/Primary Peritoneal Cancer recommend olaparib as a targeted therapy as a
single agent or in combination with other treatments. [Exhibit B]
Ovarian cancer is difficult to detect and treat. Many women are already at an advanced stage of disease
when they are first diagnosed. As a result, less than half of all people diagnosed with ovarian cancer
survive more than five years after diagnosis. Data from several trials reported at the 2015 American
Association for Cancer Research (AACR) meeting showed that Lynparza can shrink or stabilize various
cancers, particularly in patients with inherited BRCA variants. Research revealed that Lynparza extends
the length of time during and after the treatment of cancer that a patient lives with the disease without
the disease getting worse.
Lynparza is the only new drug approved for ovarian cancer since 2006. This drug offers hope to women
like me with advanced ovarian cancer by targeting weaknesses cancer cells have in repairing damaged
DNA. However, at a cost of nearly $12,000 per month this therapy is unattainable without insurance
coverage. A number of health insurance plans under Blue Cross1, United Healthcare2 and Aetna3, provide
coverage for Lynparza.
The clinical value of identifying people with a BRCA mutation lies in an individual’s ability to access
appropriate care. This is the promise of precision medicine—providing the right treatment to the right
patient at the right time. Given my BRCA mutation and recurrent ovarian cancer, my medical team
believes that access to Lynpraza is a medical necessity. We respectfully request that you reverse the
denial of coverage for this therapy.
Thank you for your consideration. Your prompt attention to this appeal is greatly appreciated.
Sincerely,
[Signature]
1
http://mcgs.bcbsfl.com/?doc=Olaparib%20(Lynparza%20TM)
https://www.unitedhealthcareonline.com/ccmcontent/ProviderII/UHC/enUS/Assets/ProviderStaticFiles/ProviderStaticFilesPdf/Tools%20and%20Resources/Policies%20and%20Protocols/Medical%20Policies/Ox
_MPUB_Future_Pharmacy/Notification_Lynparza_516.pdf
3 http://www.aetna.com/products/rxnonmedicare/data/2014/ANEOPL/Antineoplastics.html
2
Sample Appeal Letter for Lynparza
in Women with Ovarian Cancer
Exhibit A
Source:
http://www.accessdata.fda.gov/drugsatfda_docs/label/2014/206162lbl.pdf
Sample Appeal Letter for Lynparza
in Women with Ovarian Cancer
Exhibit B