be proactive - don' t wait for Biogen, they're swamped

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

be proactive - don' t wait for Biogen, they're swamped

Postby batpere » Thu Feb 03, 2005 4:19 pm

Hi,

After waiting almost 2 months for Biogen to get something set up, I took matters into my own hands.

1. 9 a.m. Called Blue Cross insurance - they said they'd cover it if the doctor would fax in info supporting the need for Tysabri. They also indicated that the infusion center (only one in the phone book) was in-network.
2. called the infusion center who said to have the doctor fax in the prescription and supporting notes. They also said they would be glad to take care of the insurance stuff.
3. called the ms clinic and asked them to send the rx to the infusion center.
4. called Biogen to tell them I had things taken care of. They said they would fax the rx to the infusion center as well, and apologized for the delay.
5. an hour later the infusion center called to ask for my insurance info. They had not bothered to get it from Biogen as I had had a few home infusions of steroids a few years ago and thus they had my info. But the insurance id's are no longer the SSN, and my number was invalid now. They also said both the doctor and Biogen had faxed in the prescriptions.
6. 2pm - the infusion center called to say everything was set and scheduled the infusion for next Tuesday!

Biogen was telling me last night it could take another month or two to actually get an infusion. I wish I had realized sooner I could just get things set up myself. I can hardly believe though just how quickly things happened - 5 hours from first call to infusion scheduling. Maybe other insurances are different, but if you have Blue Cross, just call them yourself. Look for "infusion" in the Yahoo yellow pages to find a site.
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Postby HomeIVProvider » Mon Feb 07, 2005 10:55 am

I totally agree, if your doctor wants you on this, make it happen!


Another option is to do this infusion at home after you have some
initial infusion at a hospital or clinic, if your doctor agrees it would
save people some money
My business e-mail is VitalCareHomeIV@hotmail.com, anyone in the Owensboro KY area feel free to mail me. I'd love to meet some of you!!
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Welcome to the frustrating world of insurance authorization.

Postby better2gether » Fri Feb 18, 2005 9:25 am

.
Interesting suggestion from a Neurologist:

" Welcome to the frustrating world of insurance authorization.

Here's your problem.... Unless you are one of the rare individuals who can afford $2500/month for the medicine, you will have to do what your insurance wants. Your insurance plan may or may not already have a Tysabri policy. Most companies are approving Tysabri and allowing the Neurologist (or infusion site) to determine how they will get Tysabri.

Two options.... We can buy it from a specialty pharmacy and bill you and your insurance. Or we can let a specialty pharmacy buy the drug and mail it to us. Then they will bill you and your insurance for the drug and we will bill you and the insurance for the infusion. One way, the drug profit (and risk) got to the infusion site or office and the other way, the specialty pharmacy gets the profit and accepts the risk.

I prefer to buy the product and then bill the infusion and drug out of our office. Its certainly easy and efficient. I'm accepting risk and hope to receive some profit. Some insurance companies are insisting that we not buy the drug but instead take delivery of the drug (in the patients name) through a designated specialty pharmacy (not one of our choice or the patients choice).

Where you are going wrong is by trying to work through your specialty pharmacy. You need to work through your insurance company. Call them and find out what is needed for you to get authorized. Then contact your Neurologists office and "encourage" them to do what ever it takes for the insurance company to be happy.

Good luck in the process.

I think I set a Tysabri world speed record. I saw a patient on Monday, we filled out the forms and I dictated a letter. By that afternoon, the form was faxed to MSActive and one of my employees spoke to the insurance company. She faxed my letter to them. We got approval Tuesday and infused today... 72 hrs "
.
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true

Postby DrGuy » Mon Feb 21, 2005 9:03 am

This was our experience exactly,
If you know your stuff and can make a few phone calls, you canget Tysabri approved by your insurance (United Health Care, in our case) within 2 days.
We had to wait a month for Biogen to act before we found that out.


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Postby HomeIVProvider » Mon Feb 21, 2005 11:22 am

Specialty IV Providers usually have alot of resources we can pull
from in order to get insurance companies to agree to this type of
new therapy. Most people really don't want to hassle with their
insurance due to the fact that most insurance companies really
can wear on your nerves. We can do alot of the legwork that needs
to be done in order to do whats best for the person who needs this
drug.

Their are several options out there, do whats best for you as a
person who will have to deal with this on a monthly basis.
My business e-mail is VitalCareHomeIV@hotmail.com, anyone in the Owensboro KY area feel free to mail me. I'd love to meet some of you!!
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