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    Insurance/Biogen Assistance Question

    I would like to hear about other people's experience with insurance and the help they get from Biogen when changing to Tysabri.
    I am currenly on Tecfidera and didn't have any trouble getting it approved by my insurance (BCBS of IL) and was approved for the $0 copay program through Biogen so I am paying nothing.
    I am having stomach issues with it though so have been thinking about trying Tysabri, however, I don't want to go from paying nothing, to paying a ton.
    Did you have any trouble getting Tysabri approved by your insurance? I have only been on Tec for 2 months and it is my first treatment.
    What kind of assistance do you get from biogen?
    Thanks for your help.

    #2
    Biogen will be able to help you understand your insurance coverage and their assistance programs. Yes, they will be knowledgable about your present insurance coverage by asking you just a couple of questions.

    Call Biogen Patient Services at 1-800-456-2255. These people are really on top of their game and offer clear, easy to comprehend information.

    You will be pleasantly surprised, I'm sure.

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      #3
      I had a great experience with Biogen, as far as getting help with the infusions. It was my doctor that held things up. They kept faxing the form to her office and they didn't know to fill it out. I had to go in and tell her she was holding things up and she walked me to her office manager and they got things straightened out that day. But it took a lot of calls before I finally had to go in and get it taken care of. Then they weren't sure how to charge me for the infusion costs. They charged me $10 for the first few months, don't do that anymore. I have paid nothing for the last year and a half. They tell me they always have problems with Kaiser.
      Give them a call. They can help.
      Sorry to hear you are getting stomach problems.

      Comment


        #4
        Hi ky2435,

        I Googled 'Tysabri and BCBS of IL.' With your insurance, it does look like Tysabri does fall under one of the first line of therapy treatments, so it should be no problem having it covered. My insurance requires the failure of two other DMTs first. Unlike other DMTs, it is billed under the Medical (because the drug is delivered to the infusion center and administered by medical personnel), not the prescription portion, of your policy. Mine is unusual, they changed it and it's now billed under the prescription portion of my insurance policy. (It was a real pain getting that figured out so it was covered earlier this year.).

        Have had no issues being approved for Biogen's co-pay assistance program. Just need to renew it every year, and that's not a big deal. Not sure why, but I also initially fell under the $10 co-pay, and now it's been changed to $0? When my insurance messed things up earlier this year, Biogen also offered to provide the drug at no cost to me. But, I would have been responsible for the infusion cost, so didn't go for that.

        Sorry you are having problems with Tecfidera, best of luck if you change to Tysabri.
        Kimba

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

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          #5
          I actually just found out that I will be on BCBS of Nebraska. I don't know how much of a difference that makes. That is what I am currently on. I thought I would be moving to my husband's insurance after the first of the year but we decided it was better if I stayed on my own after we looked at the deductibles and out of pocket limits further.

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            #6
            It makes a difference. According to their website-

            Avonex, Aubagio, Extavia, Gilenya, Lemtrada and Tysabri are medically necessary when all of the following are met:

            1.Prescribed to treat relapsing forms of multiple sclerosis, AND

            2.The patient has tried and failed or have a contraindication or hypersensitivity to treatment with one of the following: Betaseron, Copaxone, Rebif, Plegridy and Tecfidera.

            But since you have already tried and are having issues with Tecfidera, seems like you shouldn't have a problem being approved for Tysabri.

            Best wishes ,
            Kimba

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

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