Gilenya and insurance change/Blue Cross

[lynnem]

I am on Gilenya now with my UHC insurance, and I pay nothing once my high-deductible is met, which is awesome. But my insurance will probably be changing (if my husband takes a different job) to Blue Cross and I know that Gilenya for them is "non-preferred" and requires pre-authorization. Just wondering if anyone has dealt with Blue Cross for Gilenya, anything I need to be aware of? Anyone have any advice for the change? I'm terrified to have a gap in my meds or be forced to change. Thanks!

[Just a small town girl]

On the assumption that you mean Anthem Blue Cross / Blue Shield, that's what I have. It took about a month for them to approve my Gilenya and most of that was just because Novartis was recommending a specialty pharmacy that charged a whopping $14 more per month for the medication. I also heard 5 different stories on what my coverage was before I got the actual answer.

My advice would be to put in the request as soon as possible and call until someone will run a claim through to see what your cost actually will be and then make sure to get their name, id number and the transaction number in case it ever becomes an issue.

Hope all goes smoothly!

[metwo]

I was approved right away for Gilenya and I have the bc/bs. There are different plans though.
My co-pay is $840. a month. They have a copay assistance program that covers up to $800. of a copay so I pay $40. but you need to be approved so ask them right away. It doesn't go by your income it goes by how high your copay is. They call me one of the "under insured" really? It is not for people on medicare only those with insurance. I suppose they figure if they don't help out they won't get any money cause we won't take it. Everyones plan is different though so maybe you won't have 80/20 like I do. Yeah $840. is only 20% of the cost, it really is frickin expensive, and they already raised the price since I started!

[regigirl]

I received a letter and I thought I was approved for the co pay assistance but I got another letter today and they said I was denied assistance because we are reimbursed for our prescriptions.(80/20) Betaseron had no problem paying my co-pay. But in light of some of the controversy about G, I don't know if I'm going to try it or not. I don't know why they cant cover the cost, seems like the drug company's decision on this not my insurance, BCBS of Alabama has approved the prescription. Go figure.

[Leeaura]

I'm in Ky and have BC/BS (PPO). Every plan is different.

My dr sent an RX evaluation to BC/BS after prescribing G. I quickly rec'd an approval letter saying my copayment would b $150 each month. Dont know how this was figured....it doesn't fit in any way with our normal prescription plan.

I assume the dr notified Novartis of my copayment amount. I didn't even have to ask about assistance. Novartis called me to tell me that they would be paying my entire copayment thru 2012. This was too easy. Waiting on other shoe to drop!