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United Health Care - Sprycel

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#1 LPJohn


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Posted 17 October 2017 - 05:17 PM

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............




#2 mscl


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Posted 17 October 2017 - 07:01 PM

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.
Dx 2/10/12.
Sprycel 100. mg.
10/2015, Pleural effusions, both sides, about a 3-4 week break in Rx, reduced to 70 mg.
PEs, weren't completely gone, started building back up, about a 6-8 week break in Rx.
01/2016, Reduced to sprycel 50 mg.
10/2016, developed severe skin rash, mainly upper arms and upper legs, smaller rashes on lower arms, lower legs, upper back/neck. Rx break of about 6 weeks.
1/25/17, reduced to Sprycel 20 mg.
7/19/17, still at 20 mg Sprycel, undetectable.
11/9/17, 20 mg Sprycel, undetectable.

#3 Lori's okay

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Posted 18 October 2017 - 10:18 PM

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!

DX 09-2011 PCR 8.08 not IS WBC 17 , Began Tasigna 600mg  

in 2012 Tasigna 450mg/day ,in 2013-2017 Tasigna 300mg/day


09-11/ 8.08 not IS

03-12/ 0.054 not IS

06-12/ 0.035 not IS

09-12/ PCRU, 01-13/ PCRU

4-13/ 0.042 IS

7-13/ 0.014 IS

11-13/ PCRU, 04-14/ PCRU

8-14/ 0.006 IS

PCRU: 12-14/ 05-15/ 10-15/ 02-16/ 

09-16/ 02-17/ 09-17/ 

10-17 tapered off 

11-3-17 Stopped Tasigna

1-15-18 still PCRU


#4 LouiseS



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Posted 18 October 2017 - 11:20 PM

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.

#5 chriskuo


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Posted 19 October 2017 - 12:47 AM

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.

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