So, I had my second PCR of the year, and this time BCBS covered it. After the first one wasn't covered and my appeal denied, my onc sent a page to them from the National Comprehensive Cancer Network guidelines and highlighted the section entitled "Quantitative RT-PCR (QPCR) using IS." Today I found out that they covered the latest PCR. I still haven't heard anything about the one that I appealed. I'll keep you apprised.
PCR Insurance Coverage
Posted 09 May 2013 - 06:43 PM
This is terrific news ! it is also tremendously helpful for any others with BCBS in other states who have had this difficulty as well. I hope others find the same success in getting their PCR tests covered. I am still waiting to see if mine was covered this year. Thanks for the update. Janne
Dx'd: 8/2008. Started Gleevec 400 mg 11/08.
Drug break 2011.
Started Tasigna 4/11 450 mg.
Reduction to 300 mg Tasigna 1/2012.
PCRU 4/2013 through 3/2015. (Reduced to 150 mg 7/2014)
12/2015 ? slightly detectable at probably less than 0.01% per Mayo Clinic.
4/2016 PCRU. Still at 150 mg Tasigna.
CESSATION: stopped treatment 7/20/2017.
9/6/2017: barely detectable at 0.01%.
12/11/2017: PCR at 0.09% (did not do the monthly PCR testing.)
12/18/2017: Inevitable call from Onc. Started back on Tasigna at 150 mg. (Considering Sprycel low dose.)
Posted 22 May 2013 - 07:42 PM
Here's an update. As I said, my latest PCR was covered, but my first one of 2013 was denied. Today BCBS told me that they reviewed coverage of this type of test and, as of April first, the test is covered by BCBS. However, they are still not covering the PCR I had in January, and they're making me appeal it yet again. Gotta love insurance companies.
Posted 23 May 2013 - 12:50 PM
Excellent news! I continue to fight for PCR coverage. I have a host of denial letters from BC/BS. They now have stopped paying for BCR/ABL the letters state the testing is experimental and unnecessary for the disease. Huh?
So glad you have yours covered, with this disease the testing is a large part of the battle.
Posted 06 June 2013 - 06:35 PM
One final update. BCBS overturned their decision not to cover my first PCR of the year. Looks like I should be covered for the rest of the year. Between this and getting one of the Tasigna copay cards (mentioned in another thread), I'll be unexpectedly saving over $2000 in the next year).
Posted 30 June 2013 - 04:40 PM
The best news is, our pharmacy talked to bcbs and got them to go back and give the discounted copay for the whole time I've been on Tasigna (since July of last year).
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