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Ocrevus rejected by united Healthcare

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    Ocrevus rejected by united Healthcare

    I was diagnosed with PPMS 20 years ago
    Since then I have been on Avonex, Rebif, copaxon. Tysabri
    None stabilized my condition and MS have progressed
    Last 12 yrs , my insurance provider has been united healthcare
    In 2017 when FDA approved Ocrevus , promptly my neurologist switched my treatment and prescribed Ocrevus . It was approved by insurance and I received 2 infusions
    Late 2018 , renewal of authorization needed and united healthcare rejected authorization !!

    Stated medical record does not reflect patient benefits from treatment

    My neurologist appealed the decision saying that no medication can reverse the progress of MS and benefit to PPMS patient is not presizely measurable

    But appeal is denied too
    12 years all other treatments non- proven specifically for PP were approved by united healthcare , now Ocrevus specifically approved for PP is rejected by same insurance.

    Iím so disappointed.
    Any help Would be appreciated if you been able to resolve such situation, please share your experience

    #2
    Originally posted by brave
    Stated medical record does not reflect patient benefits from treatment
    This is just the US' immoral system of doing health care by private, for-profit corporations. Ocrevus is new and is very expensive ($60-70K/year?). That would impact the private health insurance corporation's profits and their wealthy shareholders would not receive as much money. That is literally what is happening, via multiple layers of bureaucracy and self-serving rationales (e.g. the entire "escalation theory" of MS treatment).

    Originally posted by brave
    My neurologist appealed the decision saying that no medication can reverse the progress of MS and...
    Good grief -- tell him not to say that! The immoral, private, for-profit "health" insurance corporations will use that as an excuse to cut out all treatment for MS.

    Originally posted by brave
    Any help Would be appreciated if you been able to resolve such situation, please share your experience
    No experience, sorry. I use a national health care system, the VA. While it has its drawbacks (believe me), when my doctor and I talked about Ocrevus the doc signed a form and it happened automatically -- just like it does in the UK with their wildly efficient, cheap, socialized and more effective National Health Service (NHS), and just like it does in any sane country which cares about its citizens. But here in the US, our life expectancy goes down and we force people to put up with this nonsense.

    I would suggest contacting the nat'l MS society. They'll likely have a great deal of experience in these types of situations.
    59M / RRMS / Dx1987 / Ocrevus

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      #3
      Hey brave, you still out there?

      Sorry this is so late, but I'm just reading this now, and I wanted to tell you not to give up. I also: have PPMS and have United Healthcare, and am fighting an appeal with them, and am on Ocrevus. If you are still reading here, please respond, and I'll be happy to share my experiences and thoughts with you.
      PPMS
      Dx 07/13

      Comment


        #4
        This worries me. I just decided to switch to Ocrevus and my Medicare Part D is United Healthcare aka AARP.

        Comment


          #5
          This worries me too since my current AETNA plan is being discontinued at the end of the year and I'm switching to a United Healthcare plan.

          Comment


            #6
            I'm wondering how things have turned out for everyone.

            Palmtree, did you get coverage?

            Also wondering if anyone else has been denied coverage by United Healthcare?

            Comment


              #7
              Hi
              Here is update in my side
              In 2019 , I had coverage from United healthcare through my employer
              My infusion was delayed 5 months finally United healthcare approved me for 2 infusion
              I receive one infusion after approval then my insurance changed to Medicare plan B
              Now I am covered by United healthcare AARP
              Just recently united healthcare approved my ocrevus infusion
              but I want to delay it little bit due to coronavirus😞

              Comment


                #8
                My recent February in-home treatment was approved by my
                United Healthcare AARP HMO Medicare Advantage Plan.

                Comment

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