Is there a form I need for Pegasys like there is for Besremi for me and my Dr to fill out?

[Wewo01]

I have been on the net looking to see if there was a form for Pegasys and I found nothing.

Since my insurance denied my request for Besremi, I have decided to try Pegasys.

Thanks!

Kim

[jon1972]

I'm not sure what country you are in, but in the US it's approved by FDA which in theory means insurance should cover it, but I'm not familiar with how insurance works. With the price of Besremi I'm sure they would try to get out of it if they could. Pegasys is cheaper, but not FDA approved so it's harder to get it covered by insurance. As for forms, I've never had to deal with that end of it. I've had 3 different MPN specialists and they always handled the entire appeal process with Pegasys and always came through for me. My guess is they would have a MUCH easier time succeeding with the appeal than someone who is not a doctor. Have the docs go to bat for you.

[Wewo01 in reply to jon1972]

Thank you for your reply. I appreciate it. I am in the US. My insurance stated in my denial for Besremi that Pegasys was on the formulary. I will pursue that, at the moment, and shoot for Besremi at a later date. Take Care!

Kim

[hunter5582]

Pegasys should be on the formulary and is commonly available from many specialty pharmacies. You cannot get it from your local pharmacy. Your doctor has to order it from the specialty pharmacy. The specialty pharmacy sends to your insurance for approval. Your doc may need to do a peer-to-peer approval since you are using PEG off-label.

This is exactly what I did. The approval went through with no problem. Besremi is a bit different because there are only three specialty pharmacies that carry it. Also different in it being so new that many formularies have just not caught up yet. It is not just because of the expense as you will find Jakafi (near same cost) on many formularies.

Starting on PEG if you really cannot get Besremi makes good sense, Please do let us know how it goes.

[Wewo01 in reply to hunter5582]

Hi there! I let my local hem/onc doctor know that I want to pursue the Pegasys and that there is no form like for Besremi. I also told her that I wanted it sent to my home for self administration, since she was trying to get the Besremi delivered to her infusion clinic and make me come in weekly for injections. Gah! What the heck? I am hoping that the Pegasys will keep my HCT at 42 or below, as I am getting weary of my weekly visits to Infusion clinic for PICC care, CBC's and phlebotomies(about every 2nd to 3rd week on the phlebs). Getting rid of the PICC will be liberating! I just want to get settled. I feel like everything has been so up in the air for months and months! It is certainly frustrating. Thanks for your reply and I will definitely let everyone know how it goes with Peg.

🤗

[hunter5582 in reply to Wewo01]

Home delivery should be the plan regardless of whether it is Pegasys or Besremi. It is only the first time that needs to be done at the clinic so you can be observed for an unusual reaction. Glad to hear you will be able to move forward with your plan.