Has anyone been turned down for Gilenya?

[KureMS]

I know it may be bad but,

I know it may be bad, but does your dr think that the copaxone may help? I was on avonex for 2 yrs but kept getting sick and so was switched to copaxone which i tolerate a lot better. as for cost, i was on neurontin then ins switched me to gab which was cheaper, but it did not work as well, there was ever so slight a continued deterioration in pain. so my dr switched me to lyrica, which is more expensive than neurontin. i have had to fight tooth and nail with medicare to continue with my lyrica. it's an ongoing battle with ins that just needs to stop!

I'm REALLY upset with my insurance company. As I mentioned above, I was on Avonex for two years and was not getting any results. My MRIs showed significant progression, and the side effects never let up either.

My insurance company first contended that Gilenya was "Not medically necessary." That's directly contrary to my physician's opinion.

So we filed an appeal and supported it with all sorts of documentation and an additional physician opinion. They turned me down again, this time insisting that I first undergo a course of therapy with Copaxone and prove that it doesn't work either.

This is ridiculous. In the meantime, of course, I'm getting no treatment, and my doctor says that based on the nature of my most recent MRI findings I am almost surely sustaining significant silent damage.

[KureMS]

Don't give up!

Don't give up, and yes it is riduculous! I had to file 4 appeals and fax in the SAME info 6 times! before I got resolution. This was for Lyrica which I had been taking for 3 yrs, but when I switched to Medicare this year, it was a new ball game. I only got resolution by calling in once and for every person who told me I needed to send in something, I asked to speak to someone else. Either a superior or in another department. Somehow I got an extension for someone in the Pharmacy (as opposed to a cust svc rep) and asked her to stay on the line with me as she transferred me to the correct department.

The minute they started with the "she needs to file an appeal..." the pharmacist said it was bull and wanted to speak to the lead supervisor. The pharmacist took over the call and had them jumping. My med was in my mailbox 2 days later. Point is, you'll have to keep trying till you happen upon the right person. Sorry to say it's that way. Hope things change for the better for all of us.

My appeal has been turned down twice, despite my own doctor weighing in heavily, and a second opinion submitted. It's most disappointing. Why am I paying these people a gigantic monthly premium when they won't cover what I need?