Bad news for me

[LilStep]

Just found out today that my insurance co. doesn't want to cover Tecfidera. Called Biogen and they said they are trying to figure out what they can do to help.

I hate insurance companies. Another waiting game for me...blah.

Has anyone had this problem yet? I have Blue Cross Blue Shield of Texas.

[durgastiger]

Me too lilstep!!!

Yes. I called my neurologist nurse practitioner got form in to Blue Cross Pa. on the 25th the day of my appointment and teh claim showed up in my account on the 29th and the claim is in limbo not approved but being processed.

I'm assuming they are maybe agitated because within a year I went from Copaxone to Rebif now to Tecfidera.

They may also know I have a 2 month supply of Rebif in my Frig which I'm still taking.

So I and probably a lot of others know what you are going through.

[Sunshine]

wind out of sails

I haven't posted in a long time but since I am hoping to start Tecfidera soon I thought I would check out the lastest from thr greatest. I find comfort from mt MS peers I got a call from mt Neuro on Friday who told me to come get my CBC and to sign my paperwork, for you see he knew I was anxiously wanting to get started. I went by this morning and was feeling so Happy!! Until I read these two post that is, for I too have Blue Cross Blue Sheild of NC and I have a month supply of Copaxson in the Frig! My sails are now flapping in the wind I didn't want to order the last box of Copaxson but when I first talked to my Neuro April 5th he had not had the company inservice so I ordered it, but when he called Friday night he said I could stop my Copaxson which I did...I hope Biogen will stand behind the $10 copay!!

[MiZz_JoEy]

I have BCBS of IL and I got the Tecfidera for $10...sent to me next day air via UPS for free. This is my first MS treatment so maybe that's why I didn't have any issues getting it. It took 11 days for me to receive the kit from the day my neuro faxed it.

[Sunshine]

thanks

That is encouraging information! I am trying not to worry and just enjoy not having to give myself daily shots anymore. When I had to come off Tysabri after 60 infusions because I was JC+, I told my doc I would do Copaxson but as soon as BG-12 I would be done! My llast MRI was in January showed a new lesion at T10 and an enhancing new one in my Occipital lobe in my brain. Plus the old ones were "brighter" which could possible mean there was progression as well.

The 4 1/2 years I was on Tysabri I had only 1 new lesion and that was early on...so if the insurance tries to block it I feel like there is clinical evidence to support a change in meds...We shall see Good luck and keep us posted on how you are doing with Tecfidera

[REG53]

LiStep-- Sorry about your insurance. Looks like I may be having the same problem. I have medicare part D and I was told they had no infor. about the drug yet but usually
they don't cover a new drug until it is out awhile. I talk to biogen and they said not to be concerned because they could help.

I will see my neuro next month to get me started. I hope biogen helps you soon.


MiZz_JoEy-- Glad you received you med. please let us know how you are doing.

[Scaredintn]

Sunshine, i saw in your post you went from Tysabri to another drug,.....that is my plan also, just curious did you have any significant issues when you went off the Tysabri?

[emily06]

where did you get Biogen's number to call? What is it - please. I have Medicare as my primary and BC/BS of Virginia as my Secondary

[Seasha]

Emily and others~ Here's a link from MSWorld for phone numbers to call for help http://www.msworld.org/forum/showthread.php?t=121313 Biogen is just one company listed here.

Hope this helps!

[Sunshine]

Scaredintn, I wouldn't say I had any kind of "major " flare up or new issues per say. Having said that, my MRI done in January, 8 months after I switched from Ty to Copaxson, showed a pretty significant new enhancing lesion in my occipital lobe and a new lesion at T 10 as well as brightening of some of my older lesion. I had back surgery in September for a herniated disc at L5, S1 which kept me in pain and in bed most of August and September. Its so hard to differentiate my MS, degenerative disc, and other back problems. I do know that I am so happy not to have to do injections. I have had issues with site reaction. I am pretty thin so I don't have that much fat tissues. I hit muscles on several occasions which is NO fun! This coming from an RN who work 12 years in a newborm nursery giving shots on a daily bases.

Good luck!!

[durgastiger]

MEDICARE AND bcbs?

where did you get Biogen's number to call? What is it - please. I have Medicare as my primary and BC/BS of Virginia as my Secondary

Are you retired government, teacher or nurse? Just curious.

[Lena B68]

Hi all, I just found out today I'll receive my BG 12 this Friday. I also have BCBS of CT. I don't know how, but I'm paying $10. Hope it's not a mistake on the insurance company's part. I will let u know.

[MiZz_JoEy]

Hi all, I just found out today I'll receive my BG 12 this Friday. I also have BCBS of CT. I don't know how, but I'm paying $10. Hope it's not a mistake on the insurance company's part. I will let u know.

I was pleasantly surprised when they immediately put me under the $10 copay. I also don't know why or how lol but I didn't complain! Are they sending it to you next day? They overnighted mine free of charge from Florida to Chicago thru UPS. I thought they'd charge me for it but when I logged onto the pharmacies site (Axium) I saw only a charge for the 10 dollars which I paid immediately before they changed their mind lol.

[durgastiger]

Ok. This makes sense

I have BCBS of IL and I got the Tecfidera for $10...sent to me next day air via UPS for free. This is my first MS treatment so maybe that's why I didn't have any issues getting it.

It took 11 days for me to receive the kit from the day my neuro faxed it.

If this is true for everyone then I may not get mine for another week.

[rdmc]

Just out of curiosity, how does this $10 copayment actually work. Is it a temporary price to be raised at a later date, or does Biogen expect more insurance companies to start paying once the med has been on the market awhile?

I know the other dmds have assistance programs, but this is a med that is supposed to retail for $55K a year being sent for $120 a year and since folks are getting their med by overnight shipping, that won't even cover the cost of shipping?

anyone have any insight into how, and for that matter, how long they intend to offer the med for $10. Also, I imagine there's a income test for receiving it at that price, but even if the income test was high, not many folks could afford to come out of pocket $55K a year.

Just curious if anyone understands the logic behind the copay program?