Tysabri Coverage Question

[lukeduke]

Well I have contacted my insurance company about Tysabri because when I look at my coverage on the web site it says that it is not covered. The lady I spoke with could not tell me anything because for them to even consider it I would have to have the proper "diagnosis code." I was wondering have you all had trouble getting Tysabri covered by your insurance? If you went through a program with Biogen Idec was it difficult to get the assistance?

[Myoak]

Hi Lukeduke,

Persist! Google Tysabri ActiveSource and give them a call, you will find them very helpful, they will have suggestions. Likely they will contact your insurance, with your permission, and inform you with clarity what coverage you have and what help ActiveSource provides.

Often people with a disease have two major battles, one with the disease and one with the insurance co. Sometimes insurance people are just plain wrong, other times they are deliberately ignorant, IMO. Remember, they are in business to make a profit.

Persist and you will prevail.

[LL60]

I changed insurance while on Tysabri. I use to pay nothing. Then I paid $270 a month. Now I pay over $900 a month until I reach $2500. I called Biogen and they said they could help me next January when it starts all over again.

It has been very stressful. I too had a problem getting the right codes. I yelled at my doctor because of it and she walked me out to her office manager and she got me all the numbers I needed. I keep them with all my medical records.

Good luck to you.

[anney3]

tysabri cost

It is a nightmare to weed through all the costs, etc. of tysabri. After all other infusions fail, your neurologist will suggest tysabri. That was the easy part. Next is the battle to pay for it. I have contacted many, many organizations from biogen, tysabri, cdf, nord and I was put on the waiting list. We pay 900.00 each month until 2600.00 (not sure) is paid. One time, I was called by the touch program cancelling my infusion date because I didn't pay the 900.00. No one knows what a patient has to face with ms, you have two battles the disease and the co pays, etc. I have reached the 2600. so now it is 300.00 until January 2013 and it starts all over again. Sorry, I am rambling but the infusion is helping and no one is helping.

[msesq]

Also keep in mind that some insurance companies cover Ty through their major medical plan, not their prescription plan. That is what mine does and initially I was told (by the prescription arm of my ins co) that I had no coverage only to find out that was not true, but under my plan since it is an IV infusion it is considered major medical and covered.