Insurance Approval

Discuss Ocrelizumab, a monoclonal antibody treatment for MS.

Insurance Approval

Postby CayB » Sat Aug 19, 2017 9:50 am

Aetna just turned down my doctor's request to put me on Ocrevus. I have RR and have been on Avonex and currently on Tecfidera. (Both of which they paid for.) But they want me to have failed or unable to tolerate both Copaxane and Gileyna. We're appealing, but has anyone else encountered this? :?:
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Re: Insurance Approval

Postby Lynn2024 » Fri Sep 22, 2017 3:45 pm

I have united healthcare which is through UPMC. I thought Aetna was through UPMC too. It took awhile for them to approve this. For a few months they kept denying me. Finally they approved it and I’m not sure what the problem was. It’s better if your neurologist goes through them and keeps up with it because eventually they will find the loophole and I really mean loophole they need to find
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Re: Insurance Approval

Postby CayB » Sat Sep 23, 2017 9:06 am

My doctor has handled all of the interactions with Aetna. I don't know what UPMC is - seems to be a hospital in Pittsburgh. We've gone through one appeal and it doesn't appear another one will make a difference at this point. My insurance contract gives them the right not to pay for drugs that aren't on their list and Ocrevus isn't. Of course Ocrevus didn't exist when the contact was issued. We'll see if they add Ocrevus in the next go round.

The very experienced nurse at OHSU (Oregon Health Science University) where my neuro works, says Aetna is by far the worst insurance company she deals with.
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