I've been on G for 4 weeks (2 starter kits) and now my Dr. is being told my insurance is denying it because my MS is too severe. What's going on? My Dr will do everything she can but I'm wondering if anyone else has had trouble.
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If by "too severe" you mean secondary progressive, your insurance company may be denying Gilenya because it isn't FDA approved for progressive forms of MS. Many insurance companies save money by denying off-label uses for expensive medications. (A lot of folks found this out when their insurance denied coverage for Provigil.) If you've had a couple of recent relapses, your doctor might be able to make a case by arguing that you still have a "relapsing form" of MS even though you're in the secondary progressive stage. -
My insurance company refused to pay for it. I'd taken Avonex for 2 years and still had progressing lesions. I'd also tried Copaxone for six months but I have sensitive skin and was getting painful knots after every injection.
So I'm off the pharmaceuticals altogether now. It worries me but what are you gonna do?Comment
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