Sample Appeal Letter for Lynparza in Women with Ovarian Cancer

Sample Appeal Letter for Lynparza
in Women with Ovarian Cancer

HEALTH INSURER

123 Insurance Way

Anywhere, IL 012345

DATE

RE:Claim # XXXXXXXXXXX

Insured:NAME (ID# XXXXXXXXXXX)

Claimant:NAME (DOB Mo-Day-Year)

To Whom It May Concern:

I am writing to appealthe 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, theFDA approvedolaparib(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 recommendolaparib 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 the2015 American Association for Cancer Research (AACR) meetingshowed that Lynparzacan shrink or stabilize various cancers, particularly in patients with inheritedBRCAvariants.Researchrevealed 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 Cross[1], United Healthcare[2] and Aetna[3], 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]

Exhibit A

Source:

Exhibit B

[1]

[2]

[3]