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Anyone have ExpressScripts and get Tec?

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    Anyone have ExpressScripts and get Tec?

    So my prescription insurance is though ExpressScripts. I have gone through every level of appeal and they will not approve Tec. The final letter actually states that since no head to head trial has been done between Tec and the Interferons there is no proof that Tec's are superior????? Huh - how can they say that - and how is anyone getting approved for Tec??? Isn't it my doctors decision what the "best" medicine is for me?? Is the general feeling out there that Tec is considered a drug to be used only after the failure of other drugs.

    They are also claiming I have not "failed" copaxone - who the hell defines failure - isn't that my doctors decision? I have had enhancing lesions on EVERY SINGLE MRI the entire time I did Copaxone - over 9 months...and 3 MRI's...and that is not failure?

    I am so frustrated...I am actually considering getting a lawyer but don't know if that is a waste of money. They actually said to me that FDA prescribing guidelines are being followed - but I can't fine any such guideline and neither can my neuro...I feel like they are just making it up.

    I am so frustrated...depressed...bordering on hopeless...

    #2
    Strange- I get Tec through Express Scripts

    I get Tecfidera through Express Scripts. My insurance Co. is Tri-Care Prime( For military retiree's and their family members.)
    My first perscription was in May 2013. My Nuero filled out the form provided by Express Scripts and faxed it to them.

    I had no problems getting the drug. I am newly diagnosed and Tec is the first and only therapy I've tried. They never suggested I try anything else.

    The problem may be with your insurance company approving it. It took Tri-Care about a month to decide to approve Tec.

    Good Luck

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      #3
      Thanks

      Interesting that you got it approved so easily. Unforuntaly, Medco is my perscitpion insurance and Medco was bought by ExpressScripts - so they are my actual insurer not just the the company that provides the drugs - they are the payer...and they are horrible.

      My HR department is actually fighting on my behalf - hopefully the will succeed

      Comment


        #4
        I sort of do. I had CuraScript but I think it got bought by ExpressScripts or something? They now identify themselves as Accredo but the caller ID says ExpressScripts. Anyhow, I am getting Tec through them but my ins is BCBS. I'm so sorry you're having a difficult time getting it.
        2001: 1st 2 relapses, "probable MS." 2007: 3rd relapse. Dx of RRMS confirmed by MS specialist. Started Cpx. (Off Cpx Feb 08-Mar 09 to start a family; twins!) Dec '09: Started Beta. Oct '13: Started Tecfidera. May '15: Considering Gilenya.

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          #5
          I did, and I wish I had a nice opinion to share but they were horrible. I actually had to switch insurance companies because they told me after three months of paying $25 my copayment was going to be $1500. Two days before I was due for a refill.

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            #6
            I am onTecfidera and have Express Scripts and Blue Cross, Blue Cross approved the drug, I had been on copaxone, had a relapse in Oct, and had MRI's that showed active lesions. I started tecfidera last week. Call your Insurance and not Express Scripts, they are the ones that Preauthorize the medications. Good luck.

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              #7
              If you call Tecfidera you can qualify possibly for the $10.00 copay..

              Comment


                #8
                another appeal

                to "jersey4ever" hello..that's terrible to have so much trouble getting it approved. I work as a medical collector for doctors and my experience is that you should get the insurance company involved if you haven't already. I noticed "scolavito" also said this.

                I also had no trouble getting it approved and I have an HMO through Blue Shield. I was expecting the kind of trouble you're having. Send a copy of everything you have already done, your appeals, the denials and the doctor's reports and prescriptions to your insurance company with a letter of appeal. And then do a 2nd and a 3rd if you have to. And, follow-up with phone calls to your insurance.

                The odd thing is you might not want it. I'm looking for information here because I don't like the flushing! Best of luck to you!

                ** Moderator's note - Post broken into paragraphs for easier reading. Many people with MS have visual difficulties that prevent them from reading large blocks of print. **

                Comment


                  #9
                  get agressive

                  Originally posted by jersey4ever View Post
                  So my prescription insurance is though ExpressScripts. I have gone through every level of appeal and they will not approve Tec. The final letter actually states that since no head to head trial has been done between Tec and the Interferons there is no proof that Tec's are superior????? Huh - how can they say that - and how is anyone getting approved for Tec??? Isn't it my doctors decision what the "best" medicine is for me?? Is the general feeling out there that Tec is considered a drug to be used only after the failure of other drugs.

                  They are also claiming I have not "failed" copaxone - who the hell defines failure - isn't that my doctors decision? I have had enhancing lesions on EVERY SINGLE MRI the entire time I did Copaxone - over 9 months...and 3 MRI's...and that is not failure?

                  I am so frustrated...I am actually considering getting a lawyer but don't know if that is a waste of money. They actually said to me that FDA prescribing guidelines are being followed - but I can't fine any such guideline and neither can my neuro...I feel like they are just making it up.

                  I am so frustrated...depressed...bordering on hopeless...

                  Hi jersey4ever....sorry to hear of your problem and that you're feeling so frustrated. I am wondering.....does anyone else get tec through ExpressScripts? You can probably find out here in these posts......

                  And, who is your insurance company? Do they contract out to ExpressScripts? If so, then you need to get them involved (if you haven't already) If not, send them a copy of all your appeals, denials and any medical reports as well (MRI's, etc) and Dr's prescription. Then follow-up with phone calls and keep names/notes.

                  This should be the last thing you have to deal with, on top of the condition. Hope you can get them to approve it.

                  I have heard it's very expensive ($54,000.00 a year) so that's why I'm wondering if other folks are getting it through ExpressScripts, to see if they're not approving this drug for everyone based on cost.

                  If they don't have a contract or a decent contract rate that could be the real problem, is the cost. Take care ok. Hope you can get it worked out!

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