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I WAS TURNED DOWN FOR GILENYA

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    I WAS TURNED DOWN FOR GILENYA

    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.

    ANY SUGGESTIONS?

    HUGH

    #2
    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?

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      #3
      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!

      Comment


        #4
        Yes my wife is a retired Michigan Teacher and she has filed a complaint for me with the Office Of Retirement Services.

        I have filed a grievence against Catalyst RX to try and get Gilenya.

        I have also contacted Senator Deb. Stabanow.

        I have no idea if Catalyst will get Gilenya they will not tell me.

        Hugh

        Comment


          #5
          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.

          Comment


            #6
            Originally posted by tombo131 View Post
            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.
            No I have not called them. I will try thanks.

            Hugh

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              #7
              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.
              xxxxxxxxxxx

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                #8
                Originally posted by 0485c10 View Post
                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.

                So I am am copaxone, started 2 weeks ago.

                Thanks,

                Hugh

                Comment


                  #9
                  How is the Copaxone going for you? I was my next choice if for some reason I have to stop Gilenya (like side effects.)

                  CrazyCatLady
                  MS Does Not Define Me.....My Love of Tea Does! LOL!

                  Comment


                    #10
                    Originally posted by CrazyCatLady View Post
                    How is the Copaxone going for you? I was my next choice if for some reason I have to stop Gilenya (like side effects.)
                    So far so good no side affects.

                    Thanks,

                    Hugh

                    Comment


                      #11
                      how is gilenya working for you? any relapses? does it help with fatigue or pain? i start it next week...

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