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Going off Tysabri

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    Going off Tysabri

    My Tysabri infusion was to be next week. Is anyone else having problems getting co-pay assistance? I am. I like Tysabri. It is working. However the co-pay assistance rug has been pulled out from under me. I blame Biogen.

    I was on assistance from grant. Money ran out. I knew this was going to happened months ago. So did my infusions nurse so we were proactive and applied for free drug program that would start this month. Biogen sent me letter that I qualified for the free drug program until my grant funding had been processed and paid. Then I would reapply. . Yesterday they called and told me that they were not doing briding the funding gap anymore but gave me a connection to another funding source. I qualified. BUT - I cannot get that funding until the other funding has been "exhausted". Problem is that even though I do not have enough m funding for more infusions, records show that I have $3,700 because the claims are still in the pipeline and the money has not been paid. The reason is that it takes about 60 days for claims to be processed by Medicare and another 30-60 days for the copay assistance to go through. Then I have $300 left, which doesn't cover but +/- 1/3 of my co-pay. I can not afford the $800 difference.

    My infusion nurse is battling with Biogen to get my Tysabri for free until I can get the funding issues taken care of. I decide to call too. The Biogen assistance program representative looked into my situation and told me the only options I had other than to pay out of pocket was to call Medicare and ask them to ask them to expedite the claims and to keep calling. I told him I wasn't going to do that because it would just take away Medicare's time, my time and why would they bump me above others? Medicare is already understaffed and underfunded - downsizing by attrition. I'm not blaming Medicare or asking favors. I have traditional Medicare and monitor EOBs. If billed correctly it takes 30 days to process and another 30 -45 to pay. I've never had a claim unpaid for over 90 days unless there was a coding error.

    So, no money, no medicine. ObamaCare itself doesn't have anything to do with this. Perhaps Biogent playing politics does. Some people may cry "fowl" but the only impact that law had on me personally was a smaller donut hole. Lots of problems with the ACA but traditional medicare is not a part - the advantage plans are hiking rates - that's why I went back to just Medicare. I have 101 problems but Obamacare ain't one. Being told "we want to make sure you have your medication so here it is". Then less than a week before my infusion I'm told "nope".

    I've heard there was a "kick-back" or relapse when Tysabri is stopped. Is that true?
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