Rituxan - Through Insurance NOT Compassionate Use

[Wellnesschic]

Hi All,

I keep hearing and reading about many MS patients across the country currently receiving Rituxan and it has been improved through their insurance company.

Those of you who are receiving Rituxan for MS and it is approved through your insurance company, how have you been able to get this to happen?

I have failed on all other therapies, and my neuro believes I need a b-cell depleter. The clinical argument is solid. It is the FDA language that has become the greatest issue. How are others getting around this with their insurance company?

Any help would be appreciated, I am in the middle of writing my appeal letter to the insurance company.

txs much!!

P.S.-I am very familiar with the compassionate use program through Genetech.

[gwynnf]

I am on Rituxan and did not have a problem getting the insurance to authorize which is Anthem and clearly stated in my policy that they would not authorize for MS. What insurance do you have? Did they give a specific reason why they denied?

[Pomegranate]

I have Kaiser and I had no problem getting it. My MS specialist requested it as an off label drug for me and I was approved right away. There didn't seem to be any issue. I've been on Rituxan for a little over a year and a half and I'm doing amazing! I hope you are able to get this treatment and you start doing better.

[ksl]

I have Anthem Blue Cross of CA and they denied Rituxan for MS. They cited it being used off label, and would not approve it. I was advised to try and go through the drug company for help as our income is less than $90,000. Hope you can get help paying for it. I came off Tysabri in Sept. and I have been on Rituxan almost three months, and have noticed no real difference.

[gwynnf]

I started Rituxan in October and was approved through Anthem as off label use. I don't know how my neuro did it but they are paying. I had a set back over the holidays but have just recently started noticing some real improvement. I was able to walk last night, unassisted, which I haven't done in years. I hope things improve for you...don't give up!