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SINCE MY INS. COMPANYS MEDICATION PROVIDER CATALYST RX DOES NOT HAVE IT WILL NOT PROVIDE IT FOR ME I WAS TURNED DOWN BY THE GILENYA SUPPORT TEAM FOR ASSISTANCE.
You said that your wife is a retired teacher, correct? Is she still covered by her union? It might be one place to start. If not, she's a town employee. You might want to look into other insurance options in the town (believe it or not, they sometimes use different policies between the district/town employees). If the other policies cover it, you may have a case as to why your policy should be.
Otherwise, you're probably going to have to make a case as to why you need (ie. cannot take anything else/are going to cost them more money without taking) Gilenya. If you can, you might be able to appeal. I'd start with the insurance company (get everything in writing!), then perhaps try state government. There might be a legal case, but who knows?
Could it be that the insurance company you have now just doesn't have Gilenya yet and that they might be putting it on their list soon? You know it was approved Sept 21 this year so it has not been out that long. Maybe they just dont have it Yet?
Being hopeful for you!!!!
CrazyCatLady
MS Does Not Define Me.....My Love of Tea Does! LOL!
Hugh, have you tried Novartis Patient Assistance Program? It's separate from their co-pay assistance program.
1-(800) 277-2254 or 1-(877) 408-4974 (from the pparx.org website)
I work for another big pharma company. I know with our PAP program, even if a person has insurance coverage, if they provide a basic letter from their insurance company stating they do not provide coverage on a medication that person will still be eligible to apply for PAP.
You may have already tried this - if not - hope it gets you somewhere with it.
Hugh, have you tried Novartis Patient Assistance Program? It's separate from their co-pay assistance program.
1-(800) 277-2254 or 1-(877) 408-4974 (from the pparx.org website)
I work for another big pharma company. I know with our PAP program, even if a person has insurance coverage, if they provide a basic letter from their insurance company stating they do not provide coverage on a medication that person will still be eligible to apply for PAP.
You may have already tried this - if not - hope it gets you somewhere with it.
What insurance company do you have, may i ask. There is someone who was approved for tysabri, much faster than in the past approvals I read about. I'm suspecting that the threat of going to Gilenia is making insurance companies approve tysabri faster? she had bcbs.
What insurance company do you have, may i ask. There is someone who was approved for tysabri, much faster than in the past approvals I read about. I'm suspecting that the threat of going to Gilenia is making insurance companies approve tysabri faster? she had bcbs.
We have BCBS but my wife's state retirement system along with BCBS hired Catalyst RX to manage the medications. Catalyst Rx told me that have a 6 months review periond on all ned medications to see if they will approve them or not.
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