Well Care Insurance not covering Medication

[lovingwife711]

My husband has Well Care insurance in Florida.  We are having a very hard time getting them to cover the Pegasus treatment.  Does anyone have any suggestions?

[missers]

If your insurance won't pay for the meds, Roche (manufacturers of Pegasys) has a program called "Pegassist" which helps those who can't pay for meds. If you qualify, you may get most meds for free.  Have your doctor give you the help line number or you can go to Roche's web site which i believe is roche.com.

Otherwise I suggest you put in an appeal to your insurance company along with an appeal from your doctor stating why it's important to have the drugs.  Good Luck.

[rearfang]

Also, if Pegassist (877-734-2797) turns you down based on income, ask them to put you in for "special consideration". That's what happened to me and they did decide to cover the cost. Another option is to try to get into a clinical trial such as the IDEAL study (just google the name and you'll find their web page.) From there you can find the nearest site to you. Good luck.
Lauren

[lovingwife711]

Thank you so much for the information.  My husband has type 2 and his liver byo shows that his enlargement of liver is 3 out of 4 and the cirrhosis is at 4 out of 4.  I am just so scarred of losing him.  He is 44 and we have been fighting this for the last 2 years.  Only married 3 years, I don't want to lose him.  This morning when I got the call from the pharmacist and then the doctor telling me about the insurance not covering it I felt I lost all hope.  A month ago the doctor was more at a wait and see attitude but last week he said he had to start treatment.  This forum has answered so many questions.  I wish I knew about it months ago.  With everything going on today, I forget how I even found it.
Anyway, thank you so much.

[lovingwife711]

Thank you for info.  I did not see this medication on the list that they cover, however, I still tried to sign up for it.  I am not sure whether or not we will qualify.  I own my own business.  Nothing big, however they don't always look at it that way.  I mean I make enough to make bills and all.  My husband is 100% disabled, so is income is very little.  I am in for a long fight, this I know, however, I am not the type to just give up.  Love him to much for that.  Again, Thank you!!

[honey1616]

Loving,,,Sorry to hear that you are trying to help your hubby beat this disease and then have that thrown in your path.  What is the reason that your insurance won't cover?  I hope you both get the answers that you need so you can get hubby well! Good Luck to you both!

[lovingwife711]

They said that it was a new medication and not on the list.  I have been on the phone and on the computer all day.  The last I spoke to the doctor and he was personally going to contact the insurance company.  He also told me that he had one other patent that was with this same insurance company and he had to fight a bit but in the end they ended up covering it.  I hope to hear more from them soon.  

Just want to say how nice it is to have people to talk to about this.  

Thank you all.