Tecfidera - insurance DENIED

[Dizzylizzydh]

Hi everyone,
I decided to make the leap to Tecfidera. I was just informed that my insurance (via my employer) denied me beacuse Tecfidera is new to market. The Tec rep has yet to call me (neuro submitted the paperwork a week ago). I am sure others are experiencing this. Do you think this would qualify me for the 10$ co-pay? I am just worried to start on Tec, if my insurance wont cover it, but i refuse to go nack to needles. Avonex didnt work well for me and my needle anxiety certainly did not help.
Thanks!

[MallyCT]

Same thing happened to me -- I received 3 denials; however, it was denied simply because the paperwork from my neuro with my diagnosis and relevant bloodwork just happened to cross in the mail. His office followed up with my insurance, they received the information and the process began. Could that have happened in your case as well? Regarding the $10 co-pay, whoever will be sending you the medication will let you know if you qualify -- again, that was the case for me through CVS Caremark (my Aetna Speciality Pharmacy from which I had been receiving Avonex does not yet "supply" this). You can always follow up with Biogen about the co-pay -- they should be able to provide you with the qualifications. If you poke around the threads on this page, I think someone broke it all down.

Good luck, keep us posted, and be well

[madlarjack]

Call Biogen directly. My insurance company denied. Biogen sent it to me directly free of charge while they worked it out with my insurance company. Good Luck

[Marco]

Dizzy - in your denial letter what was the exact reason given? My insurance initially would cover the starter pack, but not the maintenance dose until July 1st. Due to this odd policy, Biogen covered my medications until July 1st.

This was a real pain and took listening to hours of "on hold" music before the situation was straightened out, but I believe it was worth it.

I would have ActiveSource research your insurance situation and see if they may be able to get it approved with supplemental information or if they will cover your medication until your insurance comes around. Remind them you WANT to be on Tecfidera, but simply cannot afford it.

I hope things work out for you ... please keep us updated.

[turquoise]

I am insured with AETNA and was denied three times. My Neuro submitted an appeal to AETNA to no avail. I recently received a call from ActiveSource. After answering a few questions w an ActiveSource Rep, I was approved for assistance through Biogen. On the following day, I received a call from a specialty pharmacy and was told that I was approved to receive BG12 free w/ no co-pay. Subsequently, I received a follow-up letter from Biogen stating that I was approved for one year with no co-pay. I've been taking it for about 10 days now. Hope this information helps.

[mgb4ms]

Me, too!

I started Tec almost 2 wks ago - my HMO denied approval...which is no surprise. They deny everything the first time thru, and then some. (But they want us 'to live life well', right?...ha!). I was then referred to the Biogen and received a call that I'd be supplied with Tec for a period of 1 year free of charge. At that point, it's subject to re-review for coverage thru my HMO. For now, I'm not going to sweat it. Just grateful that drug companies see the need for benevolence towards the populations that rely on their product. Really, where would they be without our misfortune?

[Sarahsue]

My prescription for Tecfidera was also denied by my insurance because it is new to the market. For my insurance it has to be on the market for 180 days before they will consider paying for it. I was not eligible for the $10 co-pay program since I did not have a co-pay. However, I called Biogen and I qualified for a patient assistance program. I am getting my meds free for 1 year and then they will re-evaluate my need. I would call Biogen directly, just be prepared to hold for a really long time. If you can call as soon as they open in the morning.

[Dizzylizzydh]

Thanks everyone
Bot havi jumped through some hoops. I was denied because tec was not i. The formulary for my insurance. So long story short, I qualified for the free program for up to a year. Someone from active source is supposed to contact me tomorrow to get it all set up. Relieved to almost be starting but nervous too!

[tmarq23]

Originallly Denied Also

The first request was denied and the insurance company sent alternative ones that they would cover, my neurologist had to appeal/rebuttal (not sure of "proper" term) explaining that he would not put me on the intravenous ones because of my extreme anxiety towards needles (which is very accurate). After he sent this they approved it.
The insurance broker explained to me that they will always deny new medication when there is an alternative proven method available.