7 replies to this topic

[gianfranko]

My girlfriend and I recently got married and I have added her to my insurance plan since it is much better than the BCBS-FL plan she had.

I've just noticed that, under my plan, she would need preapproval for ordering gleevec.  I have never seen this before. 

Does anyone have a similar process needed to get their CML drugs on their insurance?

Who submits the approval?  The oncologist?

[LivingWellWithCML]

I am with BCBS of Georgia and they required preapproval submitted from the hematologist/onc - I imagine this is pretty common.

[pamsouth]

Hi I am Pam, DX with CML in 2005 and I live close to Indianapolis Indiana. 

I have been on Gleevec since 2005.

Our insurance is Blue Cross Of Michigan UAW Retiree.  We live in Indiana, but the automakers (that are based in this area, Indiana) the insurance operate or base is out of Michigan.  It is the CHRYSLER UAW that has contracted Blue Cross and our prescription drug coverage is contracted with Medco Acredo which will soon change their name to Express Scripts.

Anyhow my Gleevec has to be re approved or authorized ever December.   I get a letter sometime, every fall, from the UAW, to have my oncologist call a certain number to verify, I still need the Gleevec, (duh).   Then the Chrysler UAW who hold the trust funds for our insurance, has to approve the Gleevec.  Sometimes I call them and ask if it is approved for the whole next years, and they will say it is subject to change on a day to day basis depending on the world economy, or something like that.  If I ask Blue Cross about paying for labs, etc, sometimes they will refer me to the UAW who has contracted them and I get the same answer, subject to change on a day by day basis, based on the world economy.   Also our Blue Cross co pays and deductible go up every year.   We pay monthly premiums and cobra from dental and optical.  So the insurance or better said the UAW Retiree holds us hostage.

I am hoping to stay on Gleevec as it will become Generic in 2015 and hopefully drop from what is currently $6,000.00 for a 30 day supply of 400 mg, to maybe I would venture a guess of $200,00 to $300.00 a month.  My primary doctor said since CML is a rare cancer there are not that many people on it compared to other cancer drugs so I would not drop to an all time low.

PamSouth

[Happycat]

Generally, oncologist must get it preapproved. They don't want to keep paying for "chemo" if you don't need it.   (I will decline to go on my usual rant about gleevec not being chemo, the insurance companies want to think of it that way, so whatever as long as they cover it.)

Don't feel bad or worry about it. They do this with generic drugs, too. I have two dd's on high dose PPIs, one is generic, the other is a special formulation that is not generic and costs me a high copay. Anyway, insurance company had a snit over the special formulation and doctor had to write a letter stating my dd couldn't swallow pills, so needed a chewable version. For other dd, she can swallow capsules, so they insisted it be changed to a different generic drug first. Doctor doesn't even bother to fight that battle anymore. She only gets it for 90 days, and then has to get it reauthorized. Both drugs are available OTC (not chewable though), so I guess the insurance company just really wants to make sure THEY have to cover the cost, and not me.

Traci

[Susan61]

Hi Pam:  I also have Medco, and mine works the same way. Even after all these years that I am on Gleevec, they ask every year if I still need to take it.  Then my Oncologist signs the form for them.  They are Express Scripts now.  I had to write my check out to Express Scripts rather than Medco Health Solutions on one of our recent scripts.

      All these insurance companies work in different ways.

Susan

[pamsouth]

Hi Susan

My last shipment of Gleevec was 9/25/12 and it was billed auto thru my checking.  It is kind of strange the description on the bank account just gives an address with a street name in Ohio, doesn't even say Medco.

My Medicare become effective 12/1/2012.  Even though I will be 65 years on Jan 1, all Jan 1 babies are effective 1 month early, who know why.

I received this letter (9/14/12) from our Chrysler Medical Benefits Trust UAW.  The new prescription drug plan is offered thru Express Script Medicare, which was formerly Medco.  It also says "if I chose to opt out I will have NO Trust provided prescription drug coverage."  I hope the plan  is the same as I only pay $20.00 per shipment for a 30 day supply of Gleevec. 

The letter says I will be enrolled Nov/Dec and receive a new prescription drug ID card.

It also says "prior authorizations that I currently have on file will not carry over into the new plan, so I will need to get a new prior authorization when the new benefit starts. "

Again I hope that I will get the same prescription coverage.

PamSouth

[gianfranko]

Thanks everyone for the replies.  Most likely the doctor had already filed such a preapproval for my wife when she was covered under BCBS-FL.

I had one follow up question.  My wife still has the BCBS-FL coverage ongoing and I was wondering if it would be worth it to cancel the insurance or not.

I was thinking that if I ever were to loose my job, she would have trouble getting insurance that would cover her medication.  So maybe it would be worth keeping it.

The downside is that it will cost extra money and I am not sure if it would cause trouble with my insurance

[Marnie]

Typically, the preapproval only lasts for a year, so you need to fill out the paperwork annually.  Not a big deal, but make sure that you know the date so that you can have the doc fill out the paperwork and you can submit it in a timely manner.  With my insurance company, the paperwork can be submitted online. 

Marnie