Help appealing denials for this oral SERD for ESR1-mutated breast cancer.

Appeal Your Inluriyo Denial

Get access to this targeted oral therapy for ESR1-mutated advanced breast cancer.

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Understanding Your Inluriyo (imlunestrant) Denial

Inluriyo (imlunestrant) is an oral selective estrogen receptor degrader (SERD) approved for adults with ER-positive, HER2-negative, ESR1-mutated advanced breast cancer who have progressed on prior endocrine therapy. ESR1 mutations cause resistance to standard hormone therapies, making targeted treatment essential.

Common Reasons for Denial

  • ! ESR1 mutation not documented
  • ! Prior authorization required
  • ! Prior endocrine therapy not documented
  • ! Must try fulvestrant first
  • ! Specialty tier drug not covered
  • ! New drug with limited coverage policies

How We Help

We help you compile your ESR1 mutation testing results, prior endocrine therapy history, and oncologist recommendations to demonstrate medical necessity.

Start your Inluriyo appeal — it takes about 3 minutes.

Some Types of Evidence We Can Use For Supporting Your Appeal

✓ Imlunestrant is an oral SERD that degrades the estrogen receptor, including mutant ESR1 forms that cause endocrine resistance.

✓ ESR1 mutations occur in 30-40% of metastatic ER+ breast cancers after prior endocrine therapy.

✓ Clinical trials demonstrated meaningful response rates in heavily pretreated ESR1-mutated breast cancer.

✓ Oral administration offers convenience compared to injectable fulvestrant.

Financial Assistance Directory

Curated copay foundations, manufacturer programs, and safety-net clinics that may help with the cost while you appeal.

For your condition

CancerCare Co-Payment Assistance Foundation

Copay assistance for chemotherapy and targeted therapies for specific cancer diagnoses. Funds open/close by cancer type.

General copay foundations & directories

NeedyMeds

Searchable database of 5,000+ patient assistance, copay, and diagnosis-specific programs. Start here if you are not sure where to look.

Eligibility: No eligibility check - the directory itself is free. Individual programs have their own income and insurance criteria.

Patient Advocate Foundation Co-Pay Relief

Direct copay assistance for insured patients with chronic, life-threatening, or rare conditions. Covers many disease funds.

Eligibility: Generally requires insurance coverage and income up to 400% of the federal poverty level (varies by fund).

Phone: 1-866-512-3861

HealthWell Foundation

Independent charity providing copay, premium, and travel assistance grants across 70+ disease funds.

Eligibility: Must have insurance covering the prescribed treatment; income thresholds vary by fund. Funds open and close as donations allow.

The Assistance Fund (TAF)

Copay, insurance premium, and travel assistance for patients with chronic and rare diseases.

Eligibility: Must have insurance and meet income limits (typically up to 500% FPL, fund-dependent).

Good Days

Copay assistance and other support for chronic-disease patients.

Eligibility: Funds vary by disease and open/close based on availability. Usually requires insurance and income under ~500% FPL.

PAN Foundation (Patient Access Network)

Disease-specific copay assistance funds for ~70 conditions. Funds open and close throughout the year - check the website or sign up for fund-open alerts.

Eligibility: Insurance required; income limits typically 400-500% of FPL depending on the fund.

NORD (National Organization for Rare Disorders)

Patient assistance, copay, and travel programs for people living with rare diseases.

RxAssist Patient Assistance Program Center

Comprehensive directory of manufacturer patient assistance programs. Search by medication to find the manufacturer's free-drug program if you are uninsured or under-insured.

Safety-net clinics & 340B

HRSA Find a Health Center (FQHC locator)

Federally Qualified Health Centers (FQHCs) provide primary care on a sliding-fee scale and dispense many medications at 340B-discounted prices, regardless of insurance status. Often the cheapest path for uninsured or under-insured patients.

HRSA 340B Program (provider directory + program info)

Background on the 340B Drug Pricing Program. Use to verify whether a particular clinic or hospital is a covered entity before assuming discounted pricing applies.

State Pharmaceutical Assistance Program (SPAP) directory

State-run programs (mostly for seniors and people with disabilities) that supplement Medicare Part D and reduce prescription costs. Availability and benefits vary by state.

Medicaid eligibility & application (Healthcare.gov)

If denied insurance is unaffordable, check Medicaid / CHIP eligibility - thresholds and pathways vary by state, and many expansion states cover adults up to 138% FPL.

Program eligibility, fund availability, and contact info change frequently. Verify with each organization before assuming a program is open.

Patient Assistance & Copay Programs

These programs may help reduce your costs while you appeal:

Lilly Oncology Support Center ↗

Copay assistance for commercially insured patients. Lilly Cares patient assistance for eligible uninsured patients. Call 1-866-472-8663.

Eligibility requirements and program terms may change. Please verify current details directly with each organization.

Patient Advocacy & Support Organizations

These organizations provide education, support, and advocacy for patients:

National Breast Cancer Coalition ↗

Grassroots advocacy organization dedicated to ending breast cancer through research and policy.

Susan G. Komen ↗

Leading breast cancer organization funding research and providing patient support.

Frequently Asked Questions

You need documentation of an ESR1 mutation detected by an FDA-approved companion diagnostic or validated molecular testing, typically from a blood or tumor sample.

You must have received and progressed on at least one prior endocrine-based therapy (aromatase inhibitor, fulvestrant, or CDK4/6 inhibitor combination) for advanced/metastatic disease.

Inluriyo is an oral medication taken daily, while fulvestrant requires monthly injections. Inluriyo was specifically designed to work against ESR1 mutations that cause fulvestrant resistance.

Ready to Fight Your Inluriyo (imlunestrant) Denial?

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Disclaimer: Fight Health Insurance is not affiliated with, endorsed by, or partnered with any pharmaceutical manufacturer, healthcare provider, medical device company, or patient assistance program, including Eli Lilly & Co.. All information provided is for educational and informational purposes only and does not constitute medical or legal advice. Please consult with your healthcare provider regarding treatment options and with your insurance company regarding coverage decisions.