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    Happy News!!!

    I'm feeling such relief I want to jump up & down like a little kid!
    After my neuro & I decided on Aubagio we did all the necessary paperwork & sent it in. My insurance company rejected the request to cover Aubagio as it's a "Tier 5" medication.
    For them to cover it, I first must have tried & "failed" with one of 4 other meds (umm- really? do they GET what "failure" means?).

    3 of the 4 are injectables, and with my eczema, deliberately damaging my skin is not an option we want to explore. The 4th is an oral, but needs 2 doses a day. With my wacked out memory, both my neuro & I feel that I'll be more likely to be fully compliant taking meds if I only need to do it once a day. Needless to say, the frustration level was not fun.

    Genzyme approved me to get Aubagio (at no charge to me) until my insurance appeals go through (up to a year!!!), so we decided to start. I'm doing great, no sx that bother me at all, my blood tests have come back great. We're planning another MRI 6 months from my start date (that was the end of Dec).

    Thursday my dh & I went to an informational dinner Genzyme sponsored. One of the speakers was a neuro who mentioned having to help with appeals for the same type of insurance problem we're having. He says he's never not gotten an appeal approved. I begin to feel a bit hopeful.

    We chatted with the Genzyme rep later in the evening, she asked the name of my neuro. When I told her, she smiled & said "You're that patient!" She has been working with my neuro on the appeal (but only knew my initials). She had discovered that my insurance policy had a clause that states that if I have been taking a "tier 5" medication for a minimum of 6 months and it proves to be "an effective therapy", the medication will be covered by my insurance. Crazy relief!!

    It's the first thing that's made me feel some kind of hope since I accepted that I really have this monster.
    "Hope for the best and plan for the worst. That way, all your surprises will be pleasant."
    Verin Mathwin, The Wheel of Time by Robert Jordan

    #2
    Good to hear.

    I just don't get these insurance company treatment rejects when these are recommended by a MS Specialist in our best interest to help us.

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      #3
      congratulations!it must have been a "neat" feeling to have that rep say that to you! It just proves that the old saying"good things come to those who wait".
      hunterd/HuntOP/Dave
      volunteer
      MS World
      hunterd@msworld.org
      PPMS DX 2001

      "ADAPT AND OVERCOME" - MY COUSIN

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        #4
        I can just see your happy dance, Tina This is good news and it sounds like your neuro is a keeper - one who is working for you for your best interests. I love to hear these kind of stories and I really hope Aubagio is the one that works wonders for you!
        1st sx '89 Dx '99 w/RRMS - SP since 2010
        Administrator Message Boards/Moderator

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