Insurance dictating DMDs

[sllowe]

I know I'm beating a dead horse here, but I just HAVE to vent.

Received my 2nd letter from insurance pharm company regarding Rebif. Last time they basically told me it wouldn't be covered, followed by the 1,,000s it was going to cost to stay on it the very next month. Then a follow-up letter stated it would be.

So, I simmered for the better part of this year over it all, and NOW they sent a new one. Rebif is not on their "preferred" list. And, they told me to give a form they sent which says "Avonex, Betaseron, or Copax" are preferred, and my doctor is to fill out the form.

As we all know, not all meds work for everyone, and thank God our future will include checks for biomarkers for meds that will work for us individually based on our unique differences. Individualized MS treatment for individualized MS - aaaah, the mere thought of it thrills me! But, to get back to present day.......

How dare they tell me what is preferable for MY MS? Based on what? Some doctors that work for Medco that decide what "they" prefer I take? I think not.

Number 1, Avonex and betaseron are not the "exactly" the same as Rebif - the mgs are different to mention just one. Copax is not comparible to an interferon in any manner because it's a peptide and works by completely different mechanism. I could go on and on, but I won't.

To say the least - I'm fired up - I'm going to fight it with every arsenol I can put my fingers on.

I do not relapse, I'm so much better than I was in 07, and it's obvious, for now, I'm one that got lucky w/my 1st DMD attempt. No more new lesions, I'm mobile, I can talk, I can walk most times!

It's my doctors job to offer my treatment options! And, my job as a patient to decide.

Sorry I'm just so ps'st - and had to vent. Thank you all for listening.
(((Hugs)))
shell

[Jacksmom516]

It is absolutely ridiculous!  My neuro had to call my insurance co and tell them if they did not approve my MRI's she was going to sue them!  And these were my initial MRI's because they already approved ones without contrast they were not going to approve ones with -  Seriously people - Cannot wait to start seeing the bills for what they DO NOT cover and if I get a dx what they will cover of my meds! - ARGH

[michelleric]

Shell,

I hearbu and I think u can scream even louder.  Rediculous!  I think we should all move to Australia and letmtjis stress of cost of meds pass...

Thinking of you,

Michelle

[sllowe]

Yea! What you all said, and some!

Well, it's in the garbage. Doesn't matter anyway. With the switch in companies - I'm certain now it's just a "throw it out there" and see who bites.

I'm not biting - Let it be the other way around, lol.

My insurance has been good to me - never have had any problems. Sadly, the state our country is in surely adds on a whole nother layer of financial burden where insurance for all is concerned.

Thank you all for all the encouragement, and hi fives, lol Keeping my arsenol close incase I need it next year.

-Shell
p.s. Dennis - hope Dave wins that battle - find the doctor and office staff makes all the difference where meds and insurance is concerned. Hope he has some good advocates there.

[Sailorsong]

This reminded me of what my friend Dave is going through with his Diabetes. He has been fighting with his doctor at the VA because they have him on Metformin which is their preferred medicine. The only problem is that it makes him sick when he takes it. He has been fighting with them to get them to change him to something else for over a year.

Dennis  

[Lulu54]

Alex, do you have enough room for all of us to move in?  AU sounds like the perfect place for us.

Shell, this is another crazy example of insurance gone amuck.  Go get 'em tiger.  
-L

[doublevision1]

How frustrating, Shell!  I think your theory is right, that they send that generic letter to everyone hoping that it will result in some patients making a change based on what is best for the insurer, not the patient.  And if you're that frustrated - which you should be! - imagine those who are very elderly and/or slowing down cognitively and/or not educated and/or lacking in confidence - how do those patients deal with these insurers?  Without an advocate, they're at their mercy.

The physicians/medical directors who work for insurance companies - how are they in compliance with the Hippocratic Oath and their respective Code of Ethics?   They cannot be when they are making medical decisions and recommendations for patients they've never examined.  These decisions need to be made by patients and their personal physicians.  

And not to beat a dead horse myself - here I go again, lol - but to my American friends, do not believe your politicians who lie and try to scare you by telling you that 'the government' runs Canadian health care and makes medical decisions.  Our physicians make those decisions with our medical interests at heart.  The system can and does work.  As for my DMD, my neuro gave me the info and it was and still is my choice.  Sorry, for the  tangent but I get frustrated with all of the misinformation out there.  It keeps my American friends at the mercy of insurance companies whose only interest is profit.  It's a very flawed model for the practice of medicine.

[anon07072023]

I believe it.  My short term disability company was only approving 4 of the 6 weeks that my surgeon/doctor said that I needed off for my surgery.
My case manager said he had his nurses review it, and their standard is only 4 wks.  The surgeon had to call and involve their management to get it approved.

-Kelly

[sllowe]

Thanks, Alex! I'm spitting mad! I'll pat later, lol

Guess what? This just in (such a scam)....

This is what they just told me.
Since our plan is changing next year, "everyone" received that letter. So, from one person to the other regardless of the policy differences, they received a letter w/their med on it and whether it was perferrable or not and then the alternatives.

Since I have a brand name & generic policy I should see no difference. But, you never know if for some reason co-pays change, then I may pay more for it.

So for those who only have generic med coverage - they more than likely have to make the switch (unless like you say the waivers, overides, etc).

This is my thought - They throw this letter out there to everyone, hoping all will give it to their doc, and then those people end up going on the drug of their choice. The one "they" want to pay for.

I hope all who received it, threw it out w/the garbage!

[HVAC]

I hear you. It is crazy that a panel of Doctors working for the Insurance Companies or Pharmacy benefit Managers get to decide which medications people can be on. This whole thing has gotten out of hand.

Go ahead and vent. Get really mad.

Keep the faith. Do not do what I did and get so mad you quit DMDs all together. I know you are smarter than I was. I blew up at everyone and burned my bridges. It was just frustrating fighting for what I needed every three months. I was stupid and emotional. It is hard enough having this disease with out having so many obstacles thrown in your way as well.

Pat yourself on the back for taking care of yourself. Take a deep breath. Find out what steps you can take to get an over ride. Most insurances, not all, will work with your Doctor if they feel you need a certain medication over the others.

Alex