I was recently diagnosed with RRMS. I decided that I wanted to do Gileyna as my first DMT. I have Humana Access for my insurance. We looked up what the different medications would cost us and they all have the same copay. There was no mention on any restrictions. My insurance rejected Gileyna because of the cost. They want me to fail Copaxone and another injection before they will cover Gileyna.*
I chose Gileyna mainly because of the lower overall side effects, increased convenience and I found that the overall effectiveness of the drugs I was considering (Rebif, Copaxone, Gilenya, and Avonex) were about the same. My husband is afraid of needles and I would need his help with injections. I tend to get rashes on my legs so I frequently wouldn't be able to do injections there. My mom is taking interfons (not for MS) and has had a lot of bad side effects from them. I'm concerned that the same thing would happen to me.*
I can still appeal. I believe that my doctor already has and was rejected. I was supposed to start the medication in a week and a half. I know even if I decide not to appeal and chose a different DMT that it will still be a few weeks before I can start.*
So I would really prefer to avoid the injections but I don't know if I want to delay starting treatment for what could be months. How long did your appeals take? Do you have any tips for a successful appeal? I posted this in the general forum area because I am wondering about insurance appeals in general not necessarily just for Gilenya. If I have posted in the wrong area then I will gladly move my thread.
I chose Gileyna mainly because of the lower overall side effects, increased convenience and I found that the overall effectiveness of the drugs I was considering (Rebif, Copaxone, Gilenya, and Avonex) were about the same. My husband is afraid of needles and I would need his help with injections. I tend to get rashes on my legs so I frequently wouldn't be able to do injections there. My mom is taking interfons (not for MS) and has had a lot of bad side effects from them. I'm concerned that the same thing would happen to me.*
I can still appeal. I believe that my doctor already has and was rejected. I was supposed to start the medication in a week and a half. I know even if I decide not to appeal and chose a different DMT that it will still be a few weeks before I can start.*
So I would really prefer to avoid the injections but I don't know if I want to delay starting treatment for what could be months. How long did your appeals take? Do you have any tips for a successful appeal? I posted this in the general forum area because I am wondering about insurance appeals in general not necessarily just for Gilenya. If I have posted in the wrong area then I will gladly move my thread.
Comment