Announcement

Collapse
No announcement yet.

Insurance denial

Collapse
X
 
  • Filter
  • Time
  • Show
Clear All
new posts

    Insurance denial

    I've been on Guilenya for 3 weeks as my first med for MS. I got the letter that my insurance has denied me bc I have not tried and failed other drugs. From what I understand, they have appealed. What is the reality of this type of situation? I'm unfortunately a sufferer of major needle phobia. Thought of injecting myself makes me faint. I have Aetna insurance.

    #2
    Hi 2ndgeneration,

    Health insurances all have their own guidelines about which medications they'll approve as first-line meds, regardless of what the FDA says about them. Not right. It all boils down to cost.

    Aetna's guidelines for approving this medication can be found by googling Aetna and Gilenya. The very last line under Gilenya reads, "AND a documented contraindication or intolerance or allergy or failure of a one month trial each of the following preferred alternatives, Avonex or Rebif AND Copaxone." I'm sorry I couldn't share more encouraging news, but it is only one month for each. (You'll eventually look back and understand what I'm talking about.). So, all is not completely lost. Some won't cover certain ones at all.

    If it makes you feel any better, I did faint my very first injection. That was before there was an autoject pen for Avonex. They all have them, and then you won't see the syringe or needle. Just push a button and it goes in. Still never liked them, but it did a lot get easier. You might just surprise yourself that you really can do it.

    Good luck ,
    Kimba

    “When you change the way you look at things, the things you look at change.” ― Max Planck

    Comment


      #3
      I failed Copaxone and never took an interferon and Aetna approved Gilenya. I feel that I wasted a year on Copaxone though as I had the nasty reaction twice AND got new lesions- plural. But since G, no new lesions. So, you might go ahead with Copaxone- could work for you. I was and am a needle phone, but it got so that I could do a manual stomach injection. The injections in the back of the arm lead to the reaction (not enough flesh). The needle phobia did result in staying up very late every night in some magical thinking hope of avoiding the shot. The lack of sleep alone was deleterious to my health. Go ahead and appeal, but if you get the nasty Copaxone reaction- you´re done.

      Comment


        #4
        Yay for my dr

        Well, my sweet doctor worked some magic and got it cleared. Yay (I think)!!

        Originally posted by Temagami View Post
        I failed Copaxone and never took an interferon and Aetna approved Gilenya. I feel that I wasted a year on Copaxone though as I had the nasty reaction twice AND got new lesions- plural. But since G, no new lesions. So, you might go ahead with Copaxone- could work for you. I was and am a needle phone, but it got so that I could do a manual stomach injection. The injections in the back of the arm lead to the reaction (not enough flesh). The needle phobia did result in staying up very late every night in some magical thinking hope of avoiding the shot. The lack of sleep alone was deleterious to my health. Go ahead and appeal, but if you get the nasty Copaxone reaction- you´re done.

        Comment


          #5
          I wish I had more encouraging news...

          I had my first dose observation on November 25th of last year. It took until the end of April to get insurance to approve. I have United Health Care. They want you to fail either Avonex, Betaseron, Copaxone, or Tecfidera before Gilenya. I took Rebif for a little over a year. My doctor appealed FIVE times before the appeal was successful. He ended up getting the health care organization he works for to help with the last appeal.

          I was surviving on samples from a Novartis drug rep and many temporary supplies from the Navigator at Gilenya GO.
          Diagnosed with RRMS on 3/15/2013...beware the ides of March!
          Rebif from 5/2013 - 09/2014.
          Gilenya since 11/2014.
          Also taking vitamin D3, fish oil, magnesium, and B12.
          EDSS 3.

          Comment

          Working...
          X