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Of course Tysabri is excluded from my benefits

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    Of course Tysabri is excluded from my benefits

    This is really frustrating. In preparation for my dr. apt and JCV test in August, I looked up Tysabri on my benefits. It says "Plan/Benefit Exclusion" under the prescription drug coverage. So I guess Ty isn't even an option for me. This makes me really really sad.
    Diagnosed RRMS 4/7/15, symptoms for 8 months prior. Copaxone 4/27/15

    #2
    grants

    You should look into grants that would cover TY. Check with your IV provider-clinic. They should be able to help you. I'm covered by The Assistance Fund. They first covered my Copaxone expenses.

    Good luck.
    toot

    DX 1986 currently on TY
    Copaxone 2003 to February 2015

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      #3
      I would call Biogen and talk with them about prescription assistance!
      Biogen MS Active Source (Avonex, Tysabri, Tecfidera): (800) 456-2255

      I have read here on the boards that many have received the much needed assistance from them.

      Don't give up hope yet and good luck!
      1st sx '89 Dx '99 w/RRMS - SP since 2010
      Administrator Message Boards/Moderator

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        #4
        There may be a way

        So I was checking in the prescription drug listing for Ty. But then I spoke with our benefits broker (sometimes it helps to be in HR with a connection to the experts). She said that to her, it seems that because Ty is infused, if the doctor prescribes it, it runs through medical coverage as opposed to the prescription coverage and that all I would have is the co-pay. She is checking further. We will see, but keeping fingers crossed now. At least there is hope
        Diagnosed RRMS 4/7/15, symptoms for 8 months prior. Copaxone 4/27/15

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          #5
          Boymom123....
          If you are in the U.S. Biogen will likely work with you in getting you the med, even if your insurance does not cover it. I also had some strange dealings with my insurance. Something like they won't cover the medicine, but they will cover the iv administration costs. So, I am on Biogen's Free drug program. Biogen is providing the Tysabri. I/insurance is paying the "administrative" costs of the iv and hospital visit at the infusion clinic. I'm still waiting to see how much I am actually paying for that--I've had 3 infusions, but yet to be billed. In my case, it looks like it is not just a co-pay--at least no co-pay was taken at the time of service. I think it will be between $100 and $200 per infusion (until I reach deductible--which is high, but maybe I'll reach it with all of this medical stuff this year).

          Really, don't stress too much about what your insurance says related to covering Tysabri. Biogen seems to be doing a good job at working with people in these situations.
          RRMS Dx: 3/23/15
          (Optic Neuritis Dx 2/27/15; Feb/2014 right leg numbness--at the time diagnosed as Sciatica, but probably first episode)
          Started Tysabri 5/22/15: (Infusions: 5/22/15, 6/18/15, 7/16/15)

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            #6
            That is exactly how my insurance was structured; Tysabri fell under major medical. Covered; No problem; Don't worry about it.

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              #7
              Originally posted by Boymom123 View Post
              So I was checking in the prescription drug listing for Ty. But then I spoke with our benefits broker (sometimes it helps to be in HR with a connection to the experts). She said that to her, it seems that because Ty is infused, if the doctor prescribes it, it runs through medical coverage as opposed to the prescription coverage and that all I would have is the co-pay. She is checking further. We will see, but keeping fingers crossed now. At least there is hope
              Hi Boymom123,

              I was going to tell you it is not a scrip drug. Now, I see you got the info you need ! If the co-pay is too high still contact Biogen at the # given in the previous post
              Good luck
              Linda

              Comment


                #8
                In most all cases, Tysabri falls under major medical. Unless, of course, you are one of those lucky few who's plan recently changed and now has it billed through the pharmacy.

                And don't hesitate to call Biogen for co-pay assistance!
                Kimba

                “When you change the way you look at things, the things you look at change.” ― Max Planck

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                  #9
                  Seeing how I don't even have insurance. I'm going to try like heck to get it. I'll let you know how it goes.

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