Aetna

[zrjl]

Just found out that my Aetna insurance is requiring me to go to the office each week for my injection. I'm a nurse! Any suggestions on how to fight Utilization Review and get the right to do my own injections? I'm thrilled that they are paying for the cost - but that is a real inconvenience. I will have to leave work early each week for the 72 weeks!

[zrjl]

Thanks for the comments and advice. The nurse told me that Aetna would ONLY approve the Pegasys if I came to the office. SHe said they fought with them for two weeks. I had my first shot on Friday. I tried to call Aetna and got a clone on the phone who had no idea what I was talking about nor did she know who I could talk to...as confused as she was I figured if I kept talking to her I would get UNapproved and have to start over! (that would be my luck) I have written to the UM dept of Aetna, we'll see where that goes - I"m much better on paper:)
I think he was giving me the worst case scenario on the 72 weeks. I'm aiming for a lot less!

[nygirl7]

Yes that seems absolutely whacky to me too.  Tell him you'll be glad to start out to do 48 and do the shots at home and they can save all the extra weeks UNLESS you go not clear by week 12 but have had a two log drop and then ARE clear by 24, then you'll do it!  But if you are Und by week 4 / 12 and dont' relapse I cannot imagine why anyone would want to continue to 72?

Seriously you don't want to be on interferon any longer than you have to, while it's a miracle worker drug it also is a hell drug that has it's own cross to bear (ie: thyroid problems (mine's been dead since week 24) autoimmune diseases, the rashes, the lethargy.  All tolerable things but the longer you are on the meds the more chance you have of the first two being life long after you stop.

Also usually they make us all do the FIRST shot in the office and then the rest at home - maybe that is what they meant for you too.  I just thought of that.

[Trish77]

Now that's an interesting approach ... to prepare you for the absolute worst case scenario.  I think that's the first time I've heard that one .. a treatment naive person being told to be prepared for up to 72 weeks of treatment.  I hope your doctor fully explained to you under what conditions you'd be doing 72 weeks instead of the standard 48 weeks, assuming you're a Genotype 1 from that approach.

[zrjl]

Thanks to you and to nygirl7 for the info.
Nope, first time treatment - but my doc said to plan on 72 weeks, hopefully it will be shorter. I had heard of the Specialty pharmacy and was actually wondering why it wasn't going through there. I'll get back on the phone and try to sort this out.
THanks.

[nygirl7]

I have Aetna as well and while they did deny my extension to 72 weeks saying it was "experimental" they never required me to go anywhere for any shots.  In fact I think if I'd begged them on bended knee they would have laughed at me.

Have you been approved already for the 72?  Fortunately I was able to get them through the drug co. once I had that denial form in my hand.

I just can't imagine it being Aetna - maybe the doctors rules but not the insurancne company I would definitely start calling around - the force us non-nurses to do it ourselves so it makes no sense!

[FlGuy]

I've never read before that Aetna requires such a thing.  In my expereince (2 treatments) Aetna will require that a pt use the Specialty pharmacy for the med and seem to be just fine with self administration.  They may, however, require response results (labs) to demonstrate progress before continuing med refills. I'd get on the phone with them and, if possible,  try to get routed to a medical person (doctor or nurse) to get an understanding of the requirement.  Since you mention 72 weeks, I wonder if you have been through treatment already - which may cause them to consider you differently than the garden variety treatment process.