Margaret Seymour shares the struggles she had with her medical aid covering the cost of trastuzumab and how she then opted for the biosimilar.
Margaret Seymour (60) lives in Discovery, Gauteng with her husband, Richard. They have two adult daughters.
Before Margaret felt the lump in her left breast in April 2019, she had a sense that she would get cancer. When it was confirmed in June that she had HER2 triple positive breast cancer, Margaret strangely was at peace.
“Everything happened so quickly. To be honest I don’t remember everything. I recall the oncologist explaining the type of cancer and that there was a special drug that I would need; and some medical aids don’t cover it but if you motivate for it, most of the time, you receive it. But not to worry as I didn’t need the drug right away. So, I didn’t do anything until I needed the drug, which on my part was wrong. Working in optometry, I work with medical aids and thought
I knew how they function. But, now looking back, I didn’t understand my medical aid and what it covered and didn’t cover.”
The drug that Margaret needed was trastuzumab. This a monoclonal antibody, that has greatly changed the prognosis and survival of patients with HER2 positive breast cancer.
This drug would be used in combination with her second round of chemotherapy. Her first round included four weeks of Red devil. Thereafter, she would have a lumpectomy and reconstruction.
Unfortunately, Margaret’s medical aid didn’t cover the cost of trastuzumab. Even after much research and three motivations, which her oncologist assisted with, it was declined.
With Margaret’s sister-in-law being a pharmacist, she was informed, by a medical rep, about the first biosimilar of trastuzumab that had recently been approved for use in SA.
After another motivation to Margaret’s medical aid to cover the cost of the biosimilar, once again it was rejected on the terms that her plan doesn’t cover biological drugs.
Margaret had come to the decision that if she couldn’t get the originator drug or the biosimlar through her medical aid that she would then not have it.
Though, her family was having none of that. It was decided to upgrade the medical aid (the monthly premiums doubled in price) to a plan that would cover biological drugs. However, the new plan would only commence in January 2020 and Margaret needed the biosimilar by November, the latest.
This is when Margaret’s brother offered to pay cash for the two vials she needed when the second round of chemo commenced.
Confidence in the biosimilar
When asked why Margaret decided to opt for the trastuzumab biosimilar instead of the originator drug, she explains it all came down to cost.
“The biosimilar was cheaper and if we had chosen the originator drug, there would have been a co-payment when the new plan started. Plus, my oncologist was very supportive of the use of the biosimilar as there had been good results reported. And, my sister-in-law advocated it and I trust her as I know she has my best interest at heart.”
Margaret says getting the biosimilar was an answer to prayer. “I met two other breast cancer patients who didn’t have trastuzumab as part of their treatment regime due to finances and both had recurrence. So, I’m so very grateful for all my family members pushing for me to get it.”
MEET OUR EDITOR – Laurelle Williams
Laurelle Williams is the Editor at Word for Word Media. She graduated from AFDA with a Bachelor of Arts Honours degree in Live Performance. She has a love for storytelling and sharing emotions through the power of words. Her aim is to educate, encourage and most of all show there is always hope. email@example.com