Insurance is no fun :-(
sed1217
Posts: 228 Member
Granted, I am very very grateful for my insurance, which has covered the lion's share of my MS diagnostic costs over the last six months. I would really be lost without it. But that fact does not make insurance *fun* to deal with.
I am trying to start my first DMD, and I looked over the literature provided by my insurance company on drugs and coverage. All the drugs were listed as being "covered with prior authorization," which my doctor said was routine. I picked Tecfidera. He approved of my choice. Well, it turns out that the "prior authorization" step is a weed-out step for my insurance company. The company will not cover Tecfidera until I try the injectible meds. Talked to my doctor's office again about it, was told I could appeal the decision, but that the appeal could take a few weeks to resolve and would likely not come out in my favor. I could then appeal to Biogen to cover the meds, but no guarantees there.
I said no to further appeals and will be starting Rebif whenever my insurance gets around to approving that. I find the interferon drug profiles to be a little frightening, but all of the MS drug profiles are like that, frankly. At least the interferons seem to be safe, if also not terribly effective. My neuro assured me that if the interferon didn't work out, I'd be switched to Copaxone quickly. I thought about just requesting Copaxone initially, but the site reactions for it sound like no fun either. Damned if you do, damned if you don't.
I have a feeling that this is the beginning of a long and tedious existence with MS and insurance.
I am trying to start my first DMD, and I looked over the literature provided by my insurance company on drugs and coverage. All the drugs were listed as being "covered with prior authorization," which my doctor said was routine. I picked Tecfidera. He approved of my choice. Well, it turns out that the "prior authorization" step is a weed-out step for my insurance company. The company will not cover Tecfidera until I try the injectible meds. Talked to my doctor's office again about it, was told I could appeal the decision, but that the appeal could take a few weeks to resolve and would likely not come out in my favor. I could then appeal to Biogen to cover the meds, but no guarantees there.
I said no to further appeals and will be starting Rebif whenever my insurance gets around to approving that. I find the interferon drug profiles to be a little frightening, but all of the MS drug profiles are like that, frankly. At least the interferons seem to be safe, if also not terribly effective. My neuro assured me that if the interferon didn't work out, I'd be switched to Copaxone quickly. I thought about just requesting Copaxone initially, but the site reactions for it sound like no fun either. Damned if you do, damned if you don't.
I have a feeling that this is the beginning of a long and tedious existence with MS and insurance.
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Replies
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I feel for you
but if it makes you feel any better I think the injectibles are better drugs (at least they were for me until I couldn't take them any more) I actually had awesome results from the tysabri but due to my developing the JC virus I could no longer take it & because I had already tried/used all the injectibles until they no longer worked for me. I actually just started the Tecfidera & the side affect of flushing should prob be called Blazing my body was on fire. People at work were actually scolding me for allowing myself to get so sunburnt but I don't have a sunburn it was just the medicine & I looked like a fireball for 2 hrs until it started fading So maybe it is a blessing in disguise. Good luck to you with whatever meds you end up with. 0 -
The interferons and copaxone actually are fairly effective. If you look at their numbers, there Isn't a huge difference between them and the newer drugs. If rebif didn't make me feel so awful, I would still be on it. It worked wonderfully for me. The side effects for the interferons scare me a whole lot les than those for tecfidera, tysabri, and gillenya. That being said, if tecfidera is what you want, you just have to document your intolerance to the others. They won't expect you to try them all, but if you can document intolerance to rebif and then copaxone, it will force their hand. My friend had to do this when she was turned down for tysabri for the same reason as you. It took 6-9 months of trying copaxone and betaseron, but with enough documentation, she was able to get tysabri approved.0
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Thanks for the feedback. One thing I can say for Rebif's manufacturer (Merck), they are FAST. It took me less than 48 hours to get the meds in the mail - they will be here tomorrow. I think the aspect of the interferons that freaks me out the most is potentially feeling ill. I'm in a "crunch time" at work and in my career, and if I can't work, I'll be out of a career soon. So I really hope I'm not in for a 3 month flu. I've heard good things and bad things - we'll see how it goes.0
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I'm pretty new to this game and I had a pretty similar experience. I opted for Copaxone (my neuro won't prescribe oral meds), but my insurance denied it because I hadn't tried an interferon first. The flu-like side effect profile scared me to death, and I wasn't thrilled about having to have my liver enzymes checked all the time, but it hasn't been so bad. I've been on Avonex since late January and I've never gotten the flu-like side effects. I have gotten the occasional mild headache and the spot on my leg where I inject gets a bruised feeling for a few days, but that's it. I love that it's only once a week as well.
Hopefully your neuro already told you, but it really helps if you premedicate. I take Naproxen a couple hours before injecting, then repeat at injection and again a few hours later and I no longer have any side effects anymore. Hopefully you'll find a routine that really works for you as well. Good luck.0 -
Thank you for the nice response - I started my Rebif last night and your response really made me feel better about everything! Thankfully, no pain, no side effects yet. I really appreciate your support :-)0
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Good luck with the Rebif. Taking the injections is something you and your body gets used to. It is just something that is a part of my night time routine now - like brushing your teeth :laugh:
You may not get any side effects except the redness at the injections site or eventually a little divit if you don't rotate the sites enough. But you know your body more than anyone else so if you feel that something isn't quite right make a note of it and bring it to the attention of someone. I know copaxone has a 1-800 number you can call and report things to and they will assess whether or not you need to go to the doc - they will also help talk you through your injections if you find they are hard to do.
Take care
Bea0
