Insurance Denied...

[DebbieB]

Hi everyone, I just came out of a trial for Tysabri (and believe I was getting the TY), had to stop as I was JCV+ with an extremely high index.

Wanted to start Tecfidera, which my doc supported. After two weeks of waiting, I found out today that my Insurance denied, saying they would not approve without me trying Rebif first.

I've been on Avonex and Copaxone. Avonex no longer worked, and despite being on for years, I never did get over the "flu-like" symptoms. Copaxone made me feel like I was having a heart attack. Hung with it for about a month, and then doc pulled me off.

I'm secondary progressive and I suppose I'm fortunate for my insurance to cover any DMD, but I'm extremely disappointed that my insurance won't cover without giving Rebif a try. I cannot even imagine trying Rebif after my Avonex run.

Gilenya is out for a least 6 months as doc wants a washout period.

Is Tec worth giving Rebif (ugh) a try just to get the insurance approval?

Support appreciated; advice even better...

[KitOP]

Hi,
Talk to your Dr and see if they will file an appeal with the insurance company. Many times this is beneficial and successful.

You can also try to see if you can get financial assistance to help pay for the Tec thru the drug co.

there are options for you out there. Don't give up!

Good Luck!!

[BikeChik]

I was denied gilenya when I changed insurance this year. I had been on Rebif before switching to gilenya so my neuro filed an appeal and I found out today that the appeal was accepted. Hopefully your neuro will send an appeal because it can work. Good luck!

[Thinkimjob]

This is ridiculous! Why can't you have the Tec? Why do you have to go through the whole Rebif bollocks first? Yes, rhetorical question, but aaaarrgghhh.

Obviously this means "they" don't believe one is any better than the other, which apparently is not so, according to the trials.

We're all so desperate. I'd think about taking cyanide, if "they" assured me it was a cure.

[nosrepmodnar]

Sorry you have such a cranky insurance company.
Maybe your neuro can petition because of needle fatigue and site reactions (Okay, is it bad to encourage a little white lying?)

[REG53]

Hello DebbieB,

Sorry about your insurance. I get assist. from Biogen the drug co. that makes Tec.

Give them a call.

[DebbieB]

Thanks so much....

...for the support and advice. I will definitely ask Neuro to appeal (didn't even know that was possible). I'll also call Biogen and ask for assistance in lobbying with my insurance. They definitely have a vested interested given the cost (is it really true that Tec costs 55K annually?).

Yes, Think...I'd take cyanide too if they told me it was a cure...we are all so desperate.

Thanks again everyone, so nice to get on today and see the responses.

[tracibk]

I am surprised because I thought Avonex was basically the same thing as Rebif, just different delivery. Hope you can get it approved. I am on Tec and have no side effects (just light flushing and heart burn in the beginning). Best of luck!