Tysabri - Covered Under Which Insurance

A board to discuss the newly-released drug Tysabri, (formerly known as Antegren) as a treatment for Multiple Sclerosis

Re: tysabri

Postby batpere » Thu Feb 24, 2005 12:27 pm

ramairdad wrote:When taking the tysabri infusions will I still take my Beta seron injections?


Your neurologist would tell you. Mine said to keep taking Avonex along with the Tysabri until the 2 year results of the SENTINEL study are released to see if Tysabri alone is good enough.
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Postby LindaR » Fri Feb 25, 2005 12:32 pm

I spoke with my contact at Biogen (for my Avonex - they call me every 12 weeks for a follow-up) last night and I told her I was thinking of going on Tysabri. She said that was great, because as you know Avonex and Tysabri are from the same manufacturer.


She said she wanted to give me a "heads up". The enrollment process to get started on Tysabri is taking anywhere from 6-8 weeks. She said they have so many people wanted to get on the drug that they are just overwhelmed.

Of those of you that have been on Avonex, you know the procedure...your doctor needs to fax in your referal to Biogen and then a Biogen reps gets back to you. They do all the leg work and let you know if your insurance covers it, etc. I asked my rep at Biogen if I could do the leg work on my own. She said I could but that the advantage to having them do it is if you find out you have a very high co-pay or deductible, she said they partner with other companies that can help defer your out of pocket costs.

Think I'll wait and let them do it.
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Postby batpere » Fri Feb 25, 2005 5:37 pm

LindaR wrote:I spoke with my contact at Biogen (for my Avonex - they call me every 12 weeks for a follow-up) last night and I told her I was thinking of going on Tysabri. She said that was great, because as you know Avonex and Tysabri are from the same manufacturer.

She said she wanted to give me a "heads up". The enrollment process to get started on Tysabri is taking anywhere from 6-8 weeks. She said they have so many people wanted to get on the drug that they are just overwhelmed.

Of those of you that have been on Avonex, you know the procedure...your doctor needs to fax in your referal to Biogen and then a Biogen reps gets back to you. They do all the leg work and let you know if your insurance covers it, etc. I asked my rep at Biogen if I could do the leg work on my own. She said I could but that the advantage to having them do it is if you find out you have a very high co-pay or deductible, she said they partner with other companies that can help defer your out of pocket costs.

Think I'll wait and let them do it.


If you wait for them to do it, 6-8 weeks would be optimistic. I did it myself in 5 hours from first call to infusion appointment scheduled. Call your insurance and find what infusion centers are in-network on your plan. Have your doctor fax the prescription to the infusion center. The infusion center will probably call your insurance and get the Tysabri approval - mine did. Blue Cross covered it under the medical part rather than the prescription part, and it ended up costing me nothing as long as the medical expenses for everyone else in my family ends up being less than $1000 this year.

But don't wait for MSActiveSource. Get involved and educate yourself on what your medical plan will cover. I'd still be waiting for them to get the first infusion scheduled if I hadn't done it myself.
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Postby MichelleMM » Sat Feb 26, 2005 7:21 am

It looks to me like it is more difficult to get insurance approval as time goes on. The companies are flooded with questions and requests and they can't keep up. When I started the Tysabri, I was the first one to call my insurance company about it and it only took them 1 day for the decision. Now, I'm seeing it is weeks. The company's know if it will be paid for and how much, it is just making all of the arrangements and setting up the transfusions that is making it harder. My advice is to keep on them until you get answers and to have your neuro's office help. I found that doing a lot of the calling yourself makes all of the difference. Sometimes the Tysabri can be arranged to be given at a hospitals short stay area more quickly than it can be arranged to be given at an infusion center or doctor's office. I was able to set up the hospital arrangement to get the Tysabri immediately, but the infusion center or elsewhere would have taken longer. Hope one of these suggestions help.

ramairdad, about the betaseron and the tysabri, that is up to your neurologist. Some people are taking only the tysabri if they are newly diagnosed, not able to take interferons or if they are not having any improvement on the interferons. If your physician feels that adding on the tysabri will help you more, he/she will have you on both the betaseron and the tysabri. The study that Biogen did with the Avenox and the Tysabri showed that the drug reduced the frequency of relapses by 54% (compared to the placebo). So the decision on whether to continue both will come from the neurologist. Good Luck to you. :)
Diagnosed 12/28/04
Tysabri since 1/11/05
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