Forced off Tecfidera to generic, and copay assistance no longer accepted toward deductible??!!

[Klclippert]

Looking for other people's experience and solutions to these issues:

1) After being on Tecfidera successfully for 7 years, I randomly received generic drug in my Sept and Oct shipments. I called my neuro and she said it was OK, so I took it (not much choice when I'd be out of meds otherwise). Nobody knows how my prescription got switched (huh?). Now for November, I'm out of meds because pharmacy won't send generic b/c they don't have a prescription for it (Duh! how would they?) and all of a sudden they need "prior authorization" again from my doctor to send me brand name Tecfidera. As this continues in a circle of craziness for over a week, I've now been off meds for almost 6 days and worried about a relapse. How long can I be off meds before I need a starter pack again to titrate up to full dose? Anyone have experience with missing so many doses? Biogen (the maker of tecfidera) will not send me free meds to hold me over because I have been taking a generic subsititute for two months. This is a huge mess. Waiting for my neuro to provide prior authorization for pharmacy to release brand name Tecfidera again, but told it could take several days. I called Blue Care Network insurance to see if this was all their fault (did they demand that pharmacy send me generic without anyone knowing?), and they said they cannot change my prescription -only the doctor can, so they deny responsibility. Any advice here?

2) At the same time this is all happening, my doc prescribed a routine MRI to get a look at where I am with lesions. (I have been symptom-free since I started Tecfidera in 2013). I called to schedule MRI and was told it would not be covered by my insurance since my deductible has not been met (there's NO WAY this is true). Biogen's copay assistance program has helped cover the cost of my Tecfidera since 2013 and each year they pay Blue Care Network until my deductible is met (usually by the end of February) and the rest of my medical care is covered 100% through the end of the year. No one has an answer for why all of a sudden my "deductible hasnt been met" when even my online Blue Care account shows $13000 paid toward my deductible. Each time I call (4x so far) Blue Care rep submits some sort of ticket and I wait another week and call back again with no resolution. Then... a google search turned up 2 articles - one saying that starting in 2018 some insurance companies were no longer allowing drug company copay assistance to count toward patient's deductibles (great, nobody from my insurance company ever notified me of this) and second article was press release from Blue Care Network themselves, saying they are doing everything they can "including working with copay assistance programs to make sure high cost meds stay available to patients." These two articles are clearly contradictory, and Im still not sure whats going on. What if starting in Jan 2021 I will owe $6600 every time I try to get Tecfidera??? What a mess!

Again - experience / advice?

Someone suggested I try to get Biogen to provide copay assistance that routes payments in a different way rather than paying the insurance company directly, so it doesn't appear that payment comes from drug company. Not sure how that would work...

Thanks for any and all input

Kristin

[Neworleanslady]

I definitely don’t have a solution, but a somewhat similar experience. I do glatirimir, generic Copaxone. My insurance company changed it from name brand. I want Copaxone name brand and my dr put in a special order then an appeal and all for me to get it, but bc/bs wont cover it. I’d recently switched to aubagio (i hated it so I switched back) and i was denied name brand Copaxone again, and i needed a new script and prior authorization for the generic. It took MANY calls to the pharmacy and to insurance for someone to finally figure this out, why my meds werent being sent. I had some messages in to my doctor during this transition time and they were supposedly calling the pharmacy and stuff and didn’t get an answer either. Once someone told me they needed a script, the dr sent them one. Still not getting med, many calls later they said they needed prior authorization. She sent that so now the pharmacy says the prior authorization is good for a year. So am getting med now. Fortunately for me I’d had a few generic shots left over from when id switched so I didn’t have to miss any.

I also take generic Ampyra (dalfampridine). They wanted to charge mee $100 a month copay which i cannot afford so i go thru rxoutreach and they sell me the med for $60 a month total, and don’t have to go thru insurance. Only thing with that is the med goes on backorder sometimes. But i try to stock up on it when they have it; i.e. get backordered script when they get it and new refill when it is time. Rxoutreach has sent me two refills one right after the other in the past.

Sorry if this is long and confusing. Good luck with your issues

[Humbrd]

I'm so sorry that is happening to you. That all sounds scary. Trying to deal with the insurance and getting your meds. That hasn't happened to me. I don't know what I would do. Best of luck with this mess.

[pamgarner]

it is not bad enough to navigate this disease!we do become insurance experts,do you still have your orginal contact with insurance?they can't just change it! or can they.call your doctor and let find your financing,sometimes they are successful.are you on medicare yet ?because that is a whole different ballgame,best of luck

[mrsmike9]

Neurologists usually have samples. CALL them and get some to keep you going. Make sure they keep you on the brand name so you can keep getting the assistance to keep you going. I ran into that with my Aubagio and the dr's office is doing all the paperwork to keep me on it. As they say, don't change anything if it's working!

[RoyceNewton]

I just had he dr (Neuro) prescribe me name brand ONLY then went to tecfidera and asked for assistance in the copay, problem solved

[rjoneslaw]

for a med to wash out it takes 25 days. thats how long it took for tecfidera to was out of my system b4 i could switch to O 3yrs ago

just saw this

[kdali]

I only know about Novartis setting up a card for copay assist so the pharmacy gets paid by what looks like a credit card.

[CV97]

I had a problem with copay accumulators this year for the first time. I had been using the copay assistance program to meet my deductible for several years.

Short story: insurance was no longer accepting the payment assistance program's money towards deductible, even though the receipts from refills showed otherwise.

Work around: ask the manufacturer's copay assistance program if they can reimburse you directly instead of giving the pharmacy the assistance card. I was able to put my $3000 deductible on credit card and then the (Aubagio) assistance program mailed a check to me once I submitted receipt. The insurance company only saw the payment from me, so then it was valid towards meeting my deductible for the year.

The turn around was pretty quick and I was able to pay off the cc charge before accruing any interest. It didn't cost me anything in the end except for time, effort, and some ibuprofen from the giant headache it all was giving me!

[tiffortat]

How did things turn out? I had some of the same issues with my neuro and pharmacy last year with dimethyl fumarate takeover.