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WHAT I HAVE DISCOVERED ABOUT THE VA

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    WHAT I HAVE DISCOVERED ABOUT THE VA

    I'm sorry this post is long but it is informative. I think so anyway. This is truly mind blowing. Some of you may already know about what I am posting but I thought I would share for those who may not know.

    A couple of weeks back I asked my PT if she would order a specific cooing best for me. She said it would not be a problem but she wasn't sure if the company was an approved vendor. Sure enough it wasn't, or so they thought.

    Not to be denied I fired off an e-mail to lady I know to see if she could lend a belong hand. She e-mailed back telling me she would see what she could do. A couple of hours later I receive an e-mail from her stating that company is an approved vendor with the Ava's and that the Miami VA has ordered several of their cooling vests.

    So, I tell my PT on my next visit. Now, here is where the cart leaves the track. Being that the Miami VA has used the company one would think that all the VA Clinics nationwide would access to that information. Well guess what, they don't. Well, I guess I should say they do but they really have to dig to find them. The NOLA VA didn't dig far enough. However, after being told the company was an approved vendor, they deep in the files and found them.

    So, my cooling vest has been ordered and will ship next Tuesday.

    But here is another issue I am going to face. My MS specialist wants me to switch to Lemtrada. I posted asking if anyone has been on that Med and did the VA pay for it. I received an answer saying it is a formulary drug for the VA and they will pay for it. The poster lives in Texas and I live in Louisiana.

    Now here's the fun part. At my PCP last week I mention the Med to her and she checked the list of the formulary drugs. Guess what, Lemtrada was not on the list. But, that was a list for NOLA. So, just because the VA in Where ever, USA has it something on their list doesn't mean the VA in BFE, USA will.

    Now that's not to say they won't pay for it. It will just take some work. Absolutely INSANE!!
    Dx'd 4/1/11. First symptoms in 2001. Avonex 4/11, Copaxone 5/12, Tecfidera 4/13 Gilenya 4/14-10/14 Currently on no DMT's, Started Aubagio 9/21/15. Back on Avonex 10/15

    It's hard to beat a person that never gives up.
    Babe Ruth

    #2
    Your friend (me) was wrong about Lemtrada being on the formulary. However, it IS available to the VA based on this Criteria for Use. The Criteria for Use is developed by the MS Centers of Excellence (yours in west coast located in Seattle, Washington).

    This form is what guides your practitioner into the prescription of Lemtrada:

    http://www.va.gov/MS/Professionals/m...ia_for_Use.pdf


    Sorry about the confusion. What I should have said is that I know the VA has patients on Lemtrada and the VA is paying for those patients to have it.

    Comment


      #3
      Thank you for the reply my friend. I was already thinking how I could go about getting Lemtrada added to the NOLA VA formulary list so I wouldn't have any issues.

      I will print this form and give it to my Neuro when I turn my Lemtrada paperwork in. I'm wondering if an e-mail to Dr. Tarver would be helpful? I say that since she is over the MSCoE education and training and she is based in Seattle. If she can't help perhaps she can point me in the right direction. We have exchanged quite a few e-mails and she has helped me with a couple of other issues I had.
      Dx'd 4/1/11. First symptoms in 2001. Avonex 4/11, Copaxone 5/12, Tecfidera 4/13 Gilenya 4/14-10/14 Currently on no DMT's, Started Aubagio 9/21/15. Back on Avonex 10/15

      It's hard to beat a person that never gives up.
      Babe Ruth

      Comment


        #4
        The MSCOE puts out guidance for use of medications that may be of use to your provider.

        Your neurologist can also request a records review from a MSCOE MS specialist. The MSCOE can also arrange a telephone call or whatever else your provider needs to help direct your care.

        I hope it works out.

        Comment


          #5
          Hi Waydwnsouth,

          For what it's worth, I don't think it will be a problem getting this drug covered by the VA, since you fulfill the criteria. Aubagio (Teriflunomide) isn't on their drug formulary either, but remember you tried that one under the VA. Other DMTs not on the drug formulary include Tecfidera (Dimethyl fumarate), Gilenya (Fingolomod), Tysabri (Natilizumab). Ampyra (Dalfampridine) is also not on their drug formulary.

          I came across this: http://www.pbm.va.gov/apps/vanationalformulary/

          Enter the drug, and it will let you know if it's on their drug formularly. The link for criteria that must be fulfilled for drugs not on the formulary is also provided: http://www.pbm.va.gov/PBM/clinicalgu...eriaforuse.asp


          http://www.va.gov/MS/Professionals/m...b_Lemtrada.asp

          Good luck,
          Kimba

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

          Comment


            #6
            Originally posted by Kimba22 View Post
            For what it's worth, I don't think it will be a problem getting this drug covered by the VA, since you fulfill the criteria.
            No, it has not been established that the criteria have been fulfilled. In jurisprudence, that's called "assuming facts not in evidence."

            This form contains the criteria for use -- exclusion and inclusion: http://www.va.gov/MS/Professionals/m...ia_for_Use.pdf

            Although the neurologist who suggested Lemtrada may have had good intentions, until the evaluating physician actually puts a check mark in one of the boxes, and if necessary, the case is decided by the necessary committees, it has not been established that the criteria have been fulfilled.

            Comment

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