‘It’s just a huge relief’: Merck agrees to gift woman expensive cancer treatment for 1 year
Cathy Martinez was diagnosed with stage 4 kidney cancer three years ago.
By Andrew Ozaki
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LINCOLN, Nebraska (KETV) — An incredible update on a Lincoln woman’s battle to continue her life-saving cancer treatments.
We first told you about Cathy Martinez, the autism advocate diagnosed with stage 4 kidney cancer three years ago.
But on June 12 her insurance company, Medica, notified her it would no longer cover Keytruda, a drug she believes has kept her cancer in check.
After several weeks of wrangling, on Monday, Martinez got some good news.
But it was not from her insurance company, but rather Merck Pharmaceutical, the company that makes the drug.
It will provide a year’s supply of Keytruda for free through its patient assistance program.
Merck provides certain medicines free to eligible patients who don’t have insurance coverage and meet income guidelines.
“It’s just a huge relief that I’m going to be able to continue to receive my cancer treatments. And just a reassurance that I won’t have regrowth,” Martinez said.
KETV Investigates reached out to the drug maker and so did her doctor after Martinez’s appeal to Medica was denied.
“I’m incredibly grateful that they expedited this and that I am able to continue my treatments and not miss any more,” Martinez said.
In June, Medica told KETV Investigates it denied Martinez’s treatments originally, citing the standard protocol of Keytruda by Merck was 24 months of treatment, even though Martinez’s doctor recommended she stay on the drug.
Medica said that the cost of the drug, which is about $28,000 every three weeks, was not a factor.
“Medica then encouraged me to file an appeal which we did, and that was denied,” Martinez said.
But not before a strange series of notifications from Medica.
“In a three-day span, they gave me three different determinations,” Martinez said.
She said she got a phone call saying the appeal was denied.
That was followed by a letter dated June 26 saying nine treatments extending to the end of the year were approved.
Then, Martinez received a phone call before any of the letters arrived, contradicting everything.
“I received a call at 9 p.m. from somebody who worked for Medica, and she stated that they were approving me for one treatment and to disregard all mailings that came from the 26th and the 27th,” Martinez said.
Medica did allow her to get one more treatment on July 6, but no more.
Again it cited safety guidelines.
“I find it very odd that my physician wants me to stay on the drug and that the drug company is wanting me to stay on the drug. But my insurance company thinks that it would be bad for me,” Martinez said.
Medica issued this statement to KETV Investigates: “Medica is sorry for this situation and the errors that led to the confusion. we can’t comment on the specifics of the member’s situation, but we are reviewing our processes and are committed to making improvements so that our members don’t experience situations like this in the future.”
Martinez is grateful to her physician and Merck.
She said she is still following through with her appeal to the State Dept. of Insurance and she contacted a number of Nebraska state senators.
“I want to press this because I know there’s other people out there like me that are being denied their drug treatments,” Martinez said.
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