Tysabri - Covered Under Which Insurance

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

Tysabri - Covered Under Which Insurance

Postby LindaR » Fri Jan 21, 2005 1:57 pm

Does anyone know if Tysabri is covered by your medical insurance or your prescription coverage?
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Postby HRWeenie » Fri Jan 21, 2005 2:14 pm

Yes -- My insurance covers Tysabri as a medical treatment - not a prescription. As a result, I have no co-pay (!). I've just had my first infusion & will be posting my experience on the Tysabri users thread.
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Tysabri and Insurance payment

Postby MichelleMM » Fri Jan 21, 2005 4:32 pm

Yes, my insurance covers the Tysabri also, but it is not on the insurance company's pharmacy formulary. Therefore, it must be given in the hospital setting at this time. Like HRWeenie said, it is considered a treatment, not a medication. I was told it was currently not covered to be given in a physicians office, but that may change in the future as more people receive it.
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Postby LindaR » Mon Jan 24, 2005 7:58 am

Thank you for the responses. The rep at my prescription coverage company (which is Eckard) said that it will be covered under my medical. Which is a good think because if it was covered under my prescription coverage I would need to pay $965 for each vial because it is non-formulatory!!!!
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Postby MOMTO3 » Mon Jan 24, 2005 3:58 pm

CAN I ASK OF THOSE OF YOU WHO SAID YOUR INSURANCE COVERED IT, WHAT IS THE INSURANCE COMPANY NAME?
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Postby DeeDee » Mon Jan 24, 2005 6:36 pm

I will be taking my first treatment in the next 2 weeks. I don't know if this has happened to any of you already on Tysabri but I got a call from Biogen today and they have offered to help with me with the cost after my insurance pays their part. I have no idea how much that will be but they have told me to call them back if I have any problems.
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Postby Arron » Mon Jan 24, 2005 7:03 pm

DeeDee, welcome to the site (you are member #1400!). This is really interesting and important information for those concerned about being able to pay for Tysabri. It would be interesting to know how they choose who to offer this to...

If you feel comfortable answering:

What were you taking prior to Tysabri? Were you getting financial assistance?

Thanks and welcome again!
-a
Disclaimer: Any information you find on this site should not be considered medical advice. All decisions should be made with the consent of your doctor, otherwise you are at your own risk.
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Postby DeeDee » Tue Jan 25, 2005 6:09 pm

I am not on anything right now. I was just diagnosed 1/12/05 however my neuro had never seen a brain lesion as large as mine either. I ask to see the MRI and can't remember much after that. Thank God my husband was with me. I am talking huge. Just one but HUGE. Also my spinal tap only showed one immoulglon band ( not sure I am spelling that right or not ). I went to him about 1 year ago because my tounge had started tingling at times. He did an MRI and it showed nothing. I have 3 first cousins with MS but at the time it went away and really I had no problems until before Thanksgiving of this year. He even went back and pulled the film from last year just to make sure he didn't miss anything and he saw nothing. He even has told me this hit me hard and fast. I had ON along with balance problems for about 3 weeks and what felt like I was having a seziure in my sleep about 2 weeks ago other than that I can feel that I am recovering. I have a really good neuro. I really trust him. I really can't say enough good about him. I really don't know why Biogen offered to help. I have medical insurance I just know it made me rest a little easier about the cost.
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How long fromfaxing Rx to Biogen until 1st treatment?

Postby batpere » Wed Jan 26, 2005 6:33 am

How long is it taking to get all the insurance stuff worked out?
I faxed the Rx to Biogen 34 days ago - they did find an infusion
center, and called to get my insurance info a week ago, but
nothing else yet. I was hoping to have the first infusion done
within a month.

Any problems getting Blue Cross to cover it? My doc wants to
keep me on Avonex too until it is seen whether Tysabri alone
is good enough and that I don't develop antibodies to Tysabri.
Any problems getting Blue Cross to cover both? I read on one
site that Blue Cross considers combination therapy with Tysabri
to be experimental (which probably means they won't pay), but
the doc said the FDA says Ty+Av is an approved combination
and not to worry about it.
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Postby dannape » Wed Jan 26, 2005 5:36 pm

My best friend has united health care, and she not only has to pay her 20.00 co pay to have it done at the dr's office, but she has to pay her 500.00 deductible up front, cause they are delivering the tysabri to her house, the insurance has been fighting her for over a month, and this is their final decision. hopefully she starts it next week, and i will be posting her results.
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Re: How long fromfaxing Rx to Biogen until 1st treatment?

Postby batpere » Thu Feb 10, 2005 7:30 pm

batpere wrote:How long is it taking to get all the insurance stuff worked out? I faxed the Rx to Biogen 34 days ago - they did find an infusion center, and called to get my insurance info a week ago, but nothing else yet. I was hoping to have the first infusion done within a month.

Any problems getting Blue Cross to cover it? My doc wants to keep me on Avonex too until it is seen whether Tysabri alone is good enough and that I don't develop antibodies to Tysabri. Any problems getting Blue Cross to cover both? I read on one site that Blue Cross considers combination therapy with Tysabri to be experimental (which probably means they won't pay), but the doc said the FDA says Ty+Av is an approved combination and not to worry about it.


Well, I made some calls myself and had it approved and the infusion appointment set up in just 5 hours. Upon arriving home after the first treatment (uneventful), I found a letter in the mailbox from Blue Cross saying I had picked an out-of-network provider. Yikes! It also said I was approved for 12 treatments in the next 90 days ??? Upon calling them, they said it was a mistake and I was covered in-network for 6 treatments during the next 6 months. They asked how long I would be taking it, and I said "for the rest of my life". No response. Hopefully it won't take that long for a cure though. They said they will reevaluate it at the end of 6 months.

Blue Cross covers it under major medical, not prescription because of the required infusion. Just have to call for (evidently just a short-term) pre-authorization.
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Postby dannape » Thu Feb 10, 2005 7:37 pm

I would say, overall, between the dr's office, and her, and the insurance company it was about 6-8 weeks before they got everything ironed out.

all i can suggest, is document everything, who you talk to, what time and date it was, what was said,,it will help tremendously if you you start getting doubletalk, it always helps if you can prove who and when you talked to someone and what they told you.

she did have her first treatment last week, has had no side effects yet, and hasn't noticed any changes yet...i think, with her, the proof will be in whether or not she has anymore episodes, and if she does, how bad they are.

Wish I could help more, but that's all i have for now.

good luck, and god bless you.
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Insurance Coverage

Postby sorormp3 » Thu Feb 24, 2005 8:24 am

My insurance will cover me at 100% with my $15 copayment.
I was so excited I cried. They finally called me yesterday.
I have United HealthCare insurance.
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Postby flora68 » Thu Feb 24, 2005 9:58 am

My neurologist is one of those billing $4,000.00 per infusion. 8O

My insurance (AMIL International Insurance, PPO "Green"), would have paid 80% of allowed amount and I'd pay the other 20%, up to the annual out-of-pocket max of $1,000.00. Which I would hit during the second transfusion! :roll:

However, with my neurologist's indadvertant help, I changed my mind about taking Tysabri, for the foreseeable future, in favor of LDN.
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tysabri

Postby ramairdad » Thu Feb 24, 2005 12:22 pm

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