4 replies to this topic

[LPJohn]

I am starting a new insurance plan with United Health Care (UHC) and I do not see Sprycel listed as an approved drug any where but I do see Tasigna. I called their help line and they tried to be helpful but that's about it, no results.............

 

I did google it and it shows under a link and shows Clinical Pharmacy Programs

 

Does anyone on the board have UHC and take Sprycel? If so what is the process?

 

Thanks in Advance............

 

 

John

[mscl]

My employer's group health plan has Optum Rx/Briova as the pharmacy manager which is under the UHC umbrella. My Sprycel is available under Briova's specialty pharmacy program. Maybe ask if you need to get it filled under a specialty pharmacy program.

[Lori's okay]

I don't take Sprycel, but I had to go through the same process to get Tasigna.  Our UHC pharmacy, Express-Scripts told me flat out "We don't cover that drug."  Was a scary moment.  After more digging, turns out they did cover very well, but through the specialty pharmacy Accredo.  Asking for the Specialty pharmacy coverage may be the secret code :-)

 

Good luck!

[LouiseS]

We have UHC and my husband was approved for Sprycel through Optum RX. It took about a week from his doctor prescribing the medication to getting insurance approval and then receiving the drug. It came from a specialist pharmacy and they had none in stock so that part of the process took about 4 days. The pharmacy ,CVS speciality ,were very helpful and independently pursued a discounted co pay from the pharmaceutical company so for now at least the Sprycel is free. His company is changing from Optum RX to another deliverer next year so I hope that won't alter things too much for us.

[chriskuo]

I have used all the TKIs with UHC.  If there is any initial delay, your doctor can get it approved.  With medical necessity, you may also be able to get a tier exception, if the new drug is on a higher tier than the previous drug.  Because of deals UHC makes, some TKIs may show on a lower tier than the usual specialty drugs tier.

 

Also, a lot of the hoops have to do with the plan sponsor.  UHC offers a menu of options to plan sponsors.  Depending on what the plan sponsor chooses from UHC's menu, the tiers and processes can vary significantly.  So issues people run into with UHC may actually be due to plan "features" that the sponsor has requested.  There is not really a UHC "standard".  However, there are certain features that the government/ACA require.  Stay tuned though because Trump is trying to tear down those protections.