Medical Mutual and Tecfidera Preapproval

[lawbee1979]

I have Medical Mutual Ins. They have already denied Tysabri. I now am trying for Tecfidera. Anyone have issues with MM getting approved on Tec? How long before you found out? I was originally diagnosed in October and very anxious to get something started to prevent more damage to my CNS. Thanks, Rebecca

[greaterexp]

Ah, the joys of dealing with insurance! Does the insurance company have a website explaining their tiers and which treatments might be covered? I waited quite a while to start Copaxone, but things moved along much more quickly when I simply called the insurance company myself.

I wish you well with getting a DMT started. Keep us posted!

[lawbee1979 in reply to greaterexp]

Yes, they have a prior approval protocol according to their Dec 2017 provider information sheet for Tecfidera.

Thank you, I will

[greaterexp in reply to lawbee1979]

I initially received a letter from the insurance company stating that they denied coverage of Copaxone, but with no explanation as to why. I was extremely disappointed, but after a week or so, I decided to call. When i called the insurance company, I was first told that the Copaxone had been denied only because of a small omission of information from the doctor. I called the doctor's office and explained, and somehow the ball got rolling, and I was approved. I'm not sure if it helped that the insurance company heard from a real live human, but I did want to understand why the medication would not be covered and then ask what they would cover instead. I was thinking that if I needed to, I could remind them that if left untreated, my MS could potentially result in numerous claims for treating complications from the untreated disease progression. I never had to mention it. (I doubt that my reasoning would have made a difference, but I am so glad I called.) The person I spoke with was so kind and helpful, too. I hope you get a great response when you call.

[Jenn29]

My insurance company has denied every medication I've been put on. Copaxon is not a drug I'm willing to try not that it would work anyway it isn't strong enough but Bio-Gen covered my Tysabri by supplying it to me for free same with my Avonex and Plegridy. If not for the company I would not have ever been on meds. I filed for exceptions with every drug all were denied over and over