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Cigna rejects Ocrevus prescription

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    Cigna rejects Ocrevus prescription

    Wait, what? Cigna says I have to fail two other DMTs before I can have Ocrevus. I have only failed one.

    I thought lots of people are using it as a first-line therapy. No?

    #2
    Hello Mable,

    Did they send you a letter stating that or is it something said over the phone? If it is a letter could you redact personal info and share it here, if you feel okay doing that?

    Cigna pays for my spouse's Ocrevus and I handle all issues related to treatment but I have never heard of the policy you mention. My spouse switched from Tysabri to Ocrevus but nothing was mentioned about failing on Tysabri because it was spectacularly successful.

    Since Ocrevus is priced under most MS DMTs I find their policy of failing two other DMTs before approving Ocrevus financially inexplicable in addition to being inexplicable treatment-wise. It is odd and shocking that they are not following the best practice of being on a highly-effective DMT as soon as possible to prevent disability, as studies demonstrate highly effective DMTs delay disability progression better than less effective DMTs.

    Please tell us more, if you can. Thank you, Mable, for posting about this.

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      #3
      Cigna approved Ocrevus on our second try

      For anyone who finds this thread, who might be in a similar situation ...I just learned that my neuro resubmitted a preapproval request to Cigna with more details. This time they approved it within hours.

      Yay. That's a brief relief. Now I'm all clear to start freaking out about drug side effects.

      Comment


        #4
        WTH, Cigna!

        Originally posted by Mable View Post
        For anyone who finds this thread, who might be in a similar situation ...I just learned that my neuro resubmitted a preapproval request to Cigna with more details. This time they approved it within hours.

        Yay. That's a brief relief. Now I'm all clear to start freaking out about drug side effects.
        Hm, actually, I am wrong. There was a mix up at Cigna. They can't find the appeal my doctor submitted. My doctor resubmitted the appeal on Monday, called on Tuesday to confirm it was received, and by Thursday, Cigna had lost it again. And that preapproval? Nobody knows what that was about, but apparently it wasn't for me.

        What a mess!

        Part of me wishes I would have just asked for Glatopia 3 months ago. At least I'd have some protection from this disease.
        Last edited by Seasha; 04-12-2019, 03:50 PM.

        Comment


          #5
          Originally posted by Myoak View Post
          Hello Mable,

          Did they send you a letter stating that or is it something said over the phone? If it is a letter could you redact personal info and share it here, if you feel okay doing that?

          Cigna pays for my spouse's Ocrevus and I handle all issues related to treatment but I have never heard of the policy you mention. My spouse switched from Tysabri to Ocrevus but nothing was mentioned about failing on Tysabri because it was spectacularly successful.

          Since Ocrevus is priced under most MS DMTs I find their policy of failing two other DMTs before approving Ocrevus financially inexplicable in addition to being inexplicable treatment-wise. It is odd and shocking that they are not following the best practice of being on a highly-effective DMT as soon as possible to prevent disability, as studies demonstrate highly effective DMTs delay disability progression better than less effective DMTs.

          Please tell us more, if you can. Thank you, Mable, for posting about this.
          Hi MyOak,

          Thanks for your (now old) reply. I think your spouse was approved because Tysabri is already a second line medication (in Cigna's opinion).

          My neuro wrote a lovely appeal, backed up with published research articles. But all the evidence is that Cigna isn't on the "treat early and aggressively" boat. I'm guessing they will reject the appeal.

          Of course, first they will have to find the appeal. They've misplaced two of them so far.

          How does anybody navigate this nonsense?

          Comment


            #6
            Not them, too? Cigna is my Medicare supplement.

            Comment


              #7
              Cigna eventually approved, Ocrevus working great so far

              Originally posted by palmtree View Post
              Not them, too? Cigna is my Medicare supplement.
              Cigna eventually approved my appeal. They misplaced my first appeal. I micromanaged the re-appeal (weekly calls) to ensure it didn't fall through the cracks. Finally, they approved it, and I had my two doses of Ocrevus in late July/early August.

              As an aside, my experience with Ocrevus has been good. I had a mild reaction (which could have been purely psychological) during the first half dose. I had no reaction during second. After each half dose, I experienced mild flushing in the evening and the next morning--it felt like a sunburn--but it resolved by early afternoon. I was able to work two days later, but it took 2 weeks to fully get back to full speed.

              One super remarkable thing: Two days after my first half dose my months-long bout of depression lifted. It was weird. Just woke up one morning and thought about all the things that had been bothering me, and my inner voice said, "Oh, you'll be okay. That's not a big deal..."

              Depression hasn't returned full force ever since. That was about a month ago. Yay Ocrevus!

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