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California insurance company won’t cover cancer drug Avastin

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Blue Shield of California says as of October 17, 2011, it will no longer pay for the cancer drug Avastin to treat metastatic breast cancer.

The decision, announced on the company’s web site, comes after the Food and Drug Administration (FDA) Advisory Committee ruled unanimously in June the popular, but expensive, drug should be
for use for breast cancer because it is “neither safe nor effective.”

For now, breast cancer patients using Avastin, the best-selling cancer drug in the world, should still be eligible to receive insurance coverage for the $8,000 per month medication pending a final decision by FDA Commissioner Margaret A. Hamburg.

The debate over Avastin’s breast cancer benefits has been a highly emotional and politically contentious issue. So much so, that many insurers have said they will wait for the FDA’s decision before determining if they will continue to pay for the drug.

Medicare has said it will continue to cover the drug for breast cancer regardless what the FDA decides.

If the FDA rules against Avastin for breast cancer use, it will not pull the drug off the market, but rather will limit its use for colon, kidney, brain and lung cancers. Doctors can continue to prescribe Avastin for breast cancer “off label” or for an unapproved use, but insurers are unlikely to pay for it.

Some breast cancer advocates fear now that Blue Shield — one of California’s largest insurers with 3.3 million members — has withdrawn coverage, other insurers will follow suit. They say without insurance coverage, women already taking the drug, but who can’t afford the drug’s high price tag, will be left with few options.

Blue Shield of California joins three other companies: Regence, which operates Blue Cross Blue Shield plans in the Northwest, Excellus Bluecross Blue Shield in Rochester, and Dakotacare in South Dakota, which have also decided not to pay, the New York Times reports.

Despite the testimonies of breast cancer survivors who say Avastin saved their lives, members of the FDA Advisory Committee said at the June hearing that there is no evidence to support Avastin, the brand name for bevacizumab, being given in conjunction with a chemotherapy drug is any more effective in slowing the progression of breast cancer than if the chemo drug is administered alone.

The National Comprehensive Cancer Network, an organization of major cancer hospitals, disagrees. It says Avastin benefits a subset of patients, known as “super-responders” though it's not yet clear how to identify them before the drug is administered.

The drug’s maker, Swiss company Roche, and its research partner, Genetech, located in South San Francisco, asked the FDA in August to retain Avastin’s breast cancer indication, at least for women with the most aggressive breast cancer and the fewest treatment options. The company plans to conduct another clinical trial for breast cancer in an effort to prove the drug works.

The FDA's final decision is expected later this year.

Lynette Summerill, an award-winning writer and scuba enthusiast lives in San Diego, CA with her husband and two canine kids. In addition to writing about cancer-related issues for EmpowHER, her work has been seen in newspapers and magazines around the world.


Blue Shield of California Web site. Accessed online 3 Oct. 2011 at
Accessed online 3 Oct. 2011 at http://www.blueshieldca.com
Press release: https://www.blueshieldca.com/bsc/newsroom/pr/avastin100311.jhtml

Genetech web site. Post-hearing proposal for Avastin. 4 Aug. 2011. Accessed online 3 Oct. 2011

Reuters. Medicare Will Keep Covering Roche’s Avastin. Anna Yukhananov and Alina Selyukh. 30 June 2011. Accessed online 3 Oct. 2011 at http://www.reuters.com/article/2011/06/30/us-roche-avastin-cms-idUSTRE75T50H20110630

New York Times. Blue Shield of California won’t cover breast cancer drug. Andrew Pollack. 2 Oct. 2011. Accessed online 3 Oct. 2011 at http://www.nytimes.com/2011/10/03/business/blue-shield-of-california-wont-cover-breast-cancer-drug.html

Reviewed October 4, 2011
by MIchele Blacksberg RN
Edited by Jody Smith

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We value and respect our HERWriters' experiences, but everyone is different. Many of our writers are speaking from personal experience, and what's worked for them may not work for you. Their articles are not a substitute for medical advice, although we hope you can gain knowledge from their insight.

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