Last reply


Raise your hand if you feel victimized by insurance

I have been waiting and calling almost every week to see if my kesimpta has been approved. Apparently my insurance didn't receive the Dr form to approve this medication and I can't get a hold on the patient program. I have been crying for the past couple of hours lol I don't know when this finally will go through and I'm exhausted from injecting myself everyday with copaxone. No question just wondering if everyone has similar issues.

Oooh, @Darinka - this pisses me off so much. I was fighting with my insurance company for 6 months when they finally fobbed me off onto the government insurance plan (which I now pay ~120 bucks a month for ON TOP OF MY regular health insurance premium. I'm relatively sanguine about all my MS stuff now, but I gotta say, I still get angry when I think about the delay. In my case, I was a) too old, and b) Ovcrevus was too expensive and the 'cost benefit wasn't there'. Here's a quote from my refusal letter: "... Insurance Company relies on the reimbursement recommendations from the Canadian Agency for Drugs and Technologies in Health (CADTH), our national Health Technology Assessment agency. The Canadian Agency for Drugs and Technologies in Health’s (CADTH) Canadian Drug Expert Committee (CDEC) recommends Ocrevus (ocrelizumab) be reimbursed for the management of adult patients with Primary Progressive Multiple Sclerosis (PPMS), only if the following conditions are met: 1) Therapy is initiated in patients between 18 and 55 years old with an EDSS score between 3.0 and 6.5 (based on the inclusion criteria of the ORATORIO trial) 2) There is a significant reduction in price. • Unfortunately, we are unable to approve this request as at the current list price, CADTH has determined that an 82% reduction in price would be required to meet globally accepted minimum cost-effectiveness thresholds. In addition, the age inclusion range of the ORATORIO trial has not been met. As such, the reimbursement criteria have not been met in this case." Fuckers.