Aetna and ocrevus

[Wnmaddox123]

Anyone have success on getting approved through Aetna. My second try , another dr recommended occrevus even though it was denied 2 years ago as I hadn’t tried 3 ms medicines and failed . Tried two meds and now trying to get on occrevus . Also JC virus positive and some of the meds have a higher pml risk - so I’m hoping Aetna will consider the risk on other meds. Occrevus has a risk too but my dr said it’s low and the people who got pml were on other meds where pml was a risk so not sure if occrevus caused.

[Jesmcd2 CommunityAmbassador]

Hi and welcome Wnmaddox123 I'm really sorry your having such trouble with your insurance. Give MSAA a call they open at 9am EST. Toll-Free Helpline: [phone] ex 154

They will help as much as they can. 😊

How are you feeling otherwise?🤗💕🌠

[Wnmaddox123 in reply to Jesmcd2]

I’m feeling ok. Just sick and tired of insurance

[Corran731]

Currently appealing my denial from Aetna.

[Wnmaddox123 in reply to Corran731]

How many other meds have you tried? Good luck on overturning their denial.

[Corran731 in reply to Wnmaddox123]

Just 2 which is the problem. Extavia & Tecfidera. My Neurologist took me off Tec because my JCV was so high which really limits which DMDs I can take. Fingers crossed though.

[Wnmaddox123 in reply to Corran731]

Yep 2 here as well copaxone and tecfidera so that’s great to know . Tecfidera had icky side effects. Doctors have not Been checking my jcv level though since the put me on. Ever heard of anyone winning a denial that’s only been on 2? The other medicines I’m not interested in.

[Corran731 in reply to Wnmaddox123]

I’ve heard of it but not sure if they had Aetna. On the bright side, the nurse who is handling my case talked to Gentech this week to let them know what is going on and they said that they may be able to provide assistance so that I can still get Ocrevus with no out of pocket expenses even without Aetna’s approval. I‘ll keep you updated.

[Wnmaddox123 in reply to Corran731]

That’s awesome ! Yes please do. Good luck warrior .

[Wnmaddox123 in reply to Corran731]

Hi I wanted to ask you - did your doctor do a peer to peer or a written appeal ?

[Corran731 in reply to Wnmaddox123]

He talked about both but I believe ended up doing peer to peer.

[Wnmaddox123 in reply to Corran731]

I got approved as well. Never been so happy about getting a medicine. Let us know how your first infusion goes. Waiting to have doctor review my labs , my red and white blood cells are low.

[Corran731 in reply to Wnmaddox123]

That is great! I am so happy to hear more good news.

[cshells72000]

I'm sorry that you are having trouble with it and that it gets resolved soon. I have Aetna and I'm also on Ocrevus. Getting it approved wasn't difficult. I don't know if it's because I was on several other medications before that or not that helped with getting it approved. That said taking steroids is the standard protocol for this medication and I can't tolerate steroids and it was horrible trying it without them. So next time, we did it with ACTH and that was the magic trick. Fast forward, my husband's employer decided to switch prescription insurance and they would not pay for the ACTH under any circumstances and wanted me to try and fail the steroids first. It was well documented what happens when I do and they still refused. So sad because this combination really worked for me.

[Wnmaddox123]

That’s awful .