Tysabri - Covered Under Which Insurance

LindaR

Does anyone know if Tysabri is covered by your medical insurance or your prescription coverage?

HRWeenie · Posted: Fri Jan 21, 2005 3:14 pm Post subject:

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.

MichelleMM · Posted: Fri Jan 21, 2005 5:32 pm Post subject: Tysabri and Insurance payment

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.

LindaR · Posted: Mon Jan 24, 2005 8:58 am Post subject:

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!!!!

MOMTO3 · Family Member Joined: Jan 06, 2005 Posts: 36 Location: NY

CAN I ASK OF THOSE OF YOU WHO SAID YOUR INSURANCE COVERED IT, WHAT IS THE INSURANCE COMPANY NAME?

DeeDee · Posted: Mon Jan 24, 2005 7:36 pm Post subject:

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.

Arron · Posted: Mon Jan 24, 2005 8:03 pm Post subject:

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.

DeeDee · Posted: Tue Jan 25, 2005 7:09 pm Post subject:

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.

batpere

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.

dannape · Getting to Know You... Joined: Dec 02, 2004 Posts: 13

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.

batpere

dannape · Getting to Know You... Joined: Dec 02, 2004 Posts: 13

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.

sorormp3 · Newbie Joined: Feb 24, 2005 Posts: 4

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.

flora68 · Family Elder Joined: Jul 06, 2004 Posts: 118

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

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! Rolling Eyes

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

ramairdad · Posted: Thu Feb 24, 2005 1:22 pm Post subject: tysabri

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