Covered or NOT ????????

Ok  Now I just dont know about this...I just called my insurance company (BC/BS) and I inquired about these 2 new medicines and what my co-pay would be for them.I was told that they cant give me that info!!!!I want to look at what kind of money were looking at here Beforehand!!!What the Crap!!!!!I have to wait for the Dr to write me the script first,Why write the script if I maybe cant afford the copay??It doesnt make sense to me .Ive never had a problem finding about a certain drug and what the co-pay was !!!!!

[Trish77]

This is a brand new drug so maybe things are a little different on this one - they can't tell you because they don't know or because they won't? If your doc writes a script it doesn't mean you have to take it, does it?  Also, look for the posts here that talk about the patient assistance programs for both Boceprevir/Victrelis and Telaprevir/Incivek - they seem rather accommodating.  So try not to get upset at all the different situations coming along, these are barely FDA approved so it will take a bit of time for everything to get into place.  Hang in there.

Trish

[EyesofBlue55]

They wont tell me what my copay for the ribavarin or pegasus either.I need the code.Any of you have it?????All Im trying to do is estimate my cost????Ive called before and had no problem getting information.They wont give me the info. cindy
I dont see what the big-Deal is??????

[nygirl7]

Really calm down these drugs were just approved probably insurance will have to approve and make some financial decisions on thier own. They probably just haven't decided yet. Although they certainly should know about the peg/ifn ask the doctors office to call and find out. It does matter which interferon and how many riba pills per day and things like that.........which is I guess why they'd want to see a script first.

It is sensible.

[willbb]

Cindy ..Trish is correct.this is all brand new to the docs,insco . drug companys and patients alike.

Certainly some time will be needed to get things all in order. try to be  a patient patient  :).

Will

[EyesofBlue55]

I would think they could tell me something on just the SOC if I decide thats what I want to do.That is not new-I will get my drs  office to find out.I have called before to see if a drug is covered or not and they have always told me and what the copay was.NOT this time!!!! It doesnt matter -I can wait-no hurry.cindy

[nygirl7]

Again how can they tell you if nothing is prescribed? Pegasys or PegIntron?  4 riba a day or 6 riba a day? These are very expensive medications. You dont even have a script yet to have it preapproved (which we all have to do several times during treatment) preauthorization stuff.........it's not like a typical antibiotic or sleeping pill or something like that.

My copay was only $40 a month for SOC. i have no idea about the PIs but it sounds like they are going to be quite expensive but that's just a guess because of the $200 assistance copay money and stuff.

We will find out in time when they are added into the insurance companies forumularies. It's only been a day since Tela was approved.

[EyesofBlue55]

I have since found out that my co-pay for SOC alone will be $60.00 a month.What a difference it makes when you call back and speak to someone else!!!She told me with my policy the highest co-pay I can expect from any drug is $40.00.Even with the new FDA approved drugs!!!

[nygirl7]

That was pretty easy

[SusieS2010]

It could have been easier. Vertex (Incivek site) is set up to assign a patient a case manager to do all the insurance work for you. Did you finally call the correct number? Weren't you able to get help there?

[SusieS2010]

Furthermore:"Vertex will cover co-pay or co-insurance costs up to 20% ($10,000) of the total cost of Incivek for people who have private insurance plans that cover Incivek, regardless of household income".

[ek_66]

My employer uses Restat to handle prescription drug coverage. They work to a drug formulary provided quarterly by my employer. The next update is due to be released 7/31. Restat cannot give me any details on coverage until they have the new formulary. So I have asked my employer if Incivek and Vectrelis will be considered in the next formulary. Waiting to see what is the response. I can see how I may not have a full answer until Aug 1 or perhaps Nov 1.  My  monthly copays for SOC would $100 for Pegasys and $100 for Copegus. I am still happy with my decision to start one of the Gilead clinical studies. Just approaching the end of week 5.

[Proactive]

Depending on your BCBS drug coverage rider--It should be the highest tier copay--if you have a 3 tier plan. If you have a drug rider based on percentage of drug cost, then I can't help you there.

[Mary4now]

F#$** the insurance companies

[EyesofBlue55]

I did call the Vertex number and spoke to someone.They will do this for you if your Dr is registered with them and right now hes not.The Vertex lady was going to get  the office registered with them to start helping people with insurance questions.

[SusieS2010]

Well that is good Cindy. You know that nothing happens quickly for us HCV patients. This disease has been a long lesson in patience for me.

[willbb]

"F#$** the insurance companies  "
-------------------------------------------------------------
   I think it might be a good time to play nice with them right now as $80,000.00  or thereabouts might be little tough for some of us to scrape together.

[Mary4now]

I understand, however until we can get together and tell them to hit the road their will be a small percentage of people who are able to afford insurance or qualify for it and then the rest of us are left out, so there will still be people who cant come up with the $80,000 or the insurance premiums.  
Insurance is one of the only things we do well in this country.  I dont think they care about "playing nice" either you have the insurance and the money or you dont.  I''ve never seen them do anything out of the kindness of their hearts.  
Sorry, I used to do insurance billing, and it has left a bitter taste. there has to be a better way, if they are making so much money why cant we take it over and put that money to good use?

[willbb]

I wholeheartedly agree with you about the insurance business in general.... like all big business it is all about PROFIT. As a whole they could care less whether or not they help any one of us get better.,and yes everything they do is with the bottom line taken into account.

My comment .was in respect to those now  covered  for this it is  time to take advantage of that coverage and  for those fortunate enough to have that coverage to use the insco. for all its worth  ...in other words smile at them while you are getting some of those hard paid premiums back.

Best to you mary...

Will

[tjrusert]

I guess what bothers me is that, this was not some kind of surprise decision that the FDA made.  You would think that everyone would have had their "ducks in a row" so to speak.  I mean everyone including the doctors and the insurance companies.  Im pretty sure the drug manufacturers are ready to roll.  They are in it to make a profit too.

[Mary4now]

I think our health care system is broken and occasionally you see things run smoothly and efficiently, but overall you must be your own advocate and put a lot of work into making sure "things" move properly.  
I really think these drugs should be administered by clinics or GI specialists who do a lot of this.

Hey Will, you are so sweet, best to you too.  we should be grateful for any help we get, but Insurance companies are so corrupt.  

[screaming48]

I am hoping my Drs office is going to contact my insurance co. I dont like dealing with them. I am supposed to treat in July the end of the month I think, do I need to call the Dr's office and see when to submit a script to get pre approved so that I dont have a lag in time to start the treatment, I know nothing about this, and I feel like I am at the mercy of my Dr and Insurance Co, and what I want is to know ahead of time because I like to plan ahead, see it as ocd. And I haven't even started treatment yet and I feel like my head is in a fog, I have to write down everything I need from the store when it hits my brain or it will be gone instantly.then I have to remember not to forget the list, so unreal all of this...crap

[Mary4now]

Oh, you can deal with your insurance company sometimes if they hear from you they will make a bigger effort, also if you have any problems report them to the Public Regulations Commission.  (something like that ) I had to do that once and man did they jump, I got a call from them, as a matter of fact follow up calls,  call the insurance company and ask them how to proceed, get names, take notes.  
Maybe it will go like a breeze,
good luck,
Mary

[EyesofBlue55]

This is what the people from vertex are doing for drs and patients.This is what the above number is for.To help people get their scrips approved and answer your questions.They are working with the insurance companies to help you get your approval for your meds.But your drs office has to be registered with vertex before they will help. At least this is how I am understanding it as it was explained to me from the vertex representative on the phone.cindy