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Starting Copaxone, Ins won't pay for Avonex

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    Starting Copaxone, Ins won't pay for Avonex

    I was Dx in January and sent a free month of Avonex to start..started the Avonex and my insurance decides its "not medically necessary" so now I have to switch to Copaxone. How are your side effects? On the Avonex I got the flu like symptoms-chills, major body aches, etc..

    Im a nurse and I HATE shots lol but I managed the once a week and now I will have to do the once a day *sigh*

    I have scarring from the once a week injections, any skin problems from the Copaxone?

    Thanks for your input

    #2
    Ive been on copaxone for a month now and as far as skin issues, I have gotten a few lumps under the skin and some redness. The biggest thing with copaxone is the burning and some pain after the injection. Doesnt last long tho. Mine usually lasts less than 5 minutes and that goes away with time. Some also experience itching at the injection site. I hate shots too, but I dont mind this if its going to help keep the flares at bay.

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      #3
      You will get used to the daily shots and will love having no flu like symptoms. I've been on Copax since 2007, yes the skin reaction is annoying but this is what has worked for me.

      Right after the shot press down on the injection site for about 10 seconds, do not rub, just press. Hold ice pack there for a minute or so then apply Benadryl cream to curb the itch. I don't use alcohol swabs before the shot, they just added to the sting. Instead try antibacterial baby bum wipes or just plain old soap and water.

      Let us know how you're making out.

      Jen
      RRMS 2005, Copaxone since 2007
      "I hope to be the person my dog thinks I am."

      Comment


        #4
        Hi nurse,

        Glad you are here.
        Sorry about the recent diagnosis.

        I've been on Copaxone for many years because the flu-like symptoms of my first DMD (Disease Modifying Drug), Betaseron.

        It takes the body a long time to get used to Copaxone.
        Each daily shot is more difficult at first, but over months (6-8), it will get much, much better.

        Since you are a nurse (thank you, btw) you know how to inject manually.
        I suggest doing that rather than using an autoject because it's easier on the body.
        Plus, it gives you more control regarding the speed and depth of the needle. My shot is usually a count of 8-10.

        Skin reactions in the beginning will happen, so prepare yourself. Making sure no medicine touches the skin will help (wipe away with the alcohol right away). It's OK to have a small air bubble closest to the needle tip. That will help prevent the medicine touching your skin.

        Choosing areas on the body that have more fat than muscle will lessen reactions. The chart for approved areas is small, but it's alright to inject areas that are more fatty.
        The side of the upper thigh, the upper hamstring area, and even the inner thigh are areas that show less reactions.
        My arms hurt me so much afterwards, I stopped shooting there altogether.

        Get some Benadryl gel to put on the area afterwards.
        It will help reduce itchiness, but not completely take it away.
        Some people take a Benadryl pill before the shot.

        Warmer weather is quickly approaching. Just be prepared to not have the smoothest legs this summer.
        The giant lumps on my legs that first year from my shots looked awful to me.
        But, my DH encouraged me to not think about that as much as the good the medication was doing.
        Not having any changes on my MRI helped me see the value of the medication, so I stopped worrying about how my legs look in shorts.

        Just to let you know, a lesser side effect can be over all aching pain and for some, depression.
        I want to make you aware since you're a busy nurse, not to scare you away.
        Rest when you can. I take Ibuprofen regularly and that helps, too.

        Clipping the needle with a BD Clip is really convenient for me, too.
        I buy them online through Amazon, but some have found them locally.

        I understand you concerns since this is all new.
        Keep remembering that you're doing a really good thing.
        Copaxone has been proven to help repair myelin, too.
        So, that's another good thing to keep in mind as your body slowly gets used to Copaxone.

        http://www.msnewstoday.com/newly-pub...damaged-axons/

        Comment


          #5
          Appeal Insurance Decision

          Did your doctor help you appeal the insurance's company's decision to deny coverage for Avonex? It seems a bit crazy that Avonex is not medically necessary but Copaxone is medically necessary.

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            #6
            That's what I thought also! Is Avonex more expensive?

            Sara

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              #7
              Copaxone

              may be a bit more expensive!

              Comment


                #8
                Good thread! I've been on Copaxone a little less than 2 months now and some days/sites seem to sting more than others and I didn't know about the medicine touching your skin as sometimes a drop comes out when I pull the needle out.

                I've been using the autoject every day for weeks now, but I may go back to manual as it seemed like less site reactions when I did that in the beginning...

                Oh and someone wrote out inside thighs, I did that once, and only once, hurt like heck and left a small lump for a month, which I was able to eventually massage out.

                I have not used heat or ice once so far, just do my shot right after my morning shower.

                Luckily the only reaction has been the bee sting for a few minutes and sore spots (no visual bruising).

                Good luck and let us know how you do.
                Prob MS 9-14-04; Dx PPMS 9-16-11; RRMS 12-15-11
                Ampyra 10mg 2xday
                Copaxone 1/20/12

                Comment


                  #9
                  I'm pretty sure Avonex is more expensive. I've never heard of insurance covering Avonex but not Copaxone. Be sure that the copaxone is not only covered, but that they pay for it. You can still be "covered" even without them paying if you go through your insurance company.

                  The copaxone shot should be easier to tolerate.

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                    #10
                    Originally posted by its2much View Post
                    Did your doctor help you appeal the insurance's company's decision to deny coverage for Avonex? It seems a bit crazy that Avonex is not medically necessary but Copaxone is medically necessary.
                    I guess he didnt as I was called by his office and told they are switching me and sent me a form to fill out for the Capaxone...it all makes no sense to me as Im so new to all this..most of the time Im depressed or pissed off lol

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                      #11
                      Thanks for all your input! It is nice to have support from people who understand and know..Im basically starting over again with the meds. I have to fill out the info form for Capazxone, send it back to the neuro, he signs and sends it to the drug co. Then they send me some while my insurance is processed and we see if they will cover it or not. This is what I went through with the Avonex and the ins said no go. So we will see what happens now...

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                        #12
                        I spent years as a health insurance executive and I never heard of Avonex being declared "not medically necessary."

                        The cost to the insurance company is likely quite different from what you are told is "the cost" since the insurance company negotiates discount rates, so you can't really tell which one is "more expensive."

                        The two drugs are quite different so I would think if your doctor said you needed Avonex and not Copaxone, the insurer would be hard pressed to deny that. I was at a health policy conference a couple years ago where a medical director on the podium said that I was just greedy for wanting Copaxone when it was probably more expensive. In reality all the CRABs are about the same price, on average. A whole bunch of people in the audience cheered for me when I stood up and told him he was wrong.

                        So yes, you should appeal the denial if you really would prefer Avonex. It could be that your insurance company has as stupid a medical director as that one at the conference

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                          #13
                          Can't remember the exact details

                          but a couple of years ago there was an investigation of doctor's prescribing just one of the DMDs, rather than going over the four drugs and explaining the pros and cons. They were getting some sort of kickbacks.
                          I found that when I was first diagnosed and saw a few doctors for second opinions that some did push very hard for me to take a particular drug.

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                            #14
                            I talked to my neuro today and he said he did fight for the Avonex and my insurance wont budge but they will cover/help with Copaxone...the neuro also said that BCBS in my state pretty much isnt MS happy and doesnt like to do a lot for MS meds/patients...

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