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Kalydeco - insurance approval?
- Thread starter Tom
- Start date
K
Keepercjr
Guest
jmiller - according to the online info for my script company my copay is $35. I'm trying to get my doctors to prescribe it for me. Get this - the *REP* from vertex told the CF nurse at my clinic that you *can not* get Kalydeco via insurance unless you have the G551d mutation (you would have to pay out of pocket). I told the nurse that he was wrong as I know for a fact that there are some CFers out there currently trying it who don't have that mutation and their insurance covered it.
K
Keepercjr
Guest
jmiller - according to the online info for my script company my copay is $35. I'm trying to get my doctors to prescribe it for me. Get this - the *REP* from vertex told the CF nurse at my clinic that you *can not* get Kalydeco via insurance unless you have the G551d mutation (you would have to pay out of pocket). I told the nurse that he was wrong as I know for a fact that there are some CFers out there currently trying it who don't have that mutation and their insurance covered it.
Caroline- so interesting how things are not quite matching up... it sounded pretty straightforward from how Amy described it.. and yet when I asked my previous dr about it she said I woud likely have to petition Vertex?! Just let us try! I'm going to make my case and call my new dr tomorrow.
Caroline- so interesting how things are not quite matching up... it sounded pretty straightforward from how Amy described it.. and yet when I asked my previous dr about it she said I woud likely have to petition Vertex?! Just let us try! I'm going to make my case and call my new dr tomorrow.
BleedOrange1968
New member
Thanks so much for all this info! I am going Friday to my doc. She better get me a script!!! I called Caremark and they cover it for me at an $80 copay a month. I'm taking all these postings with me. Pray pray pray!!
Darryl, 44 w/cf --(DF508 & 3272-26A>G) was dx at 24
Darryl, 44 w/cf --(DF508 & 3272-26A>G) was dx at 24
BleedOrange1968
New member
Thanks so much for all this info! I am going Friday to my doc. She better get me a script!!! I called Caremark and they cover it for me at an $80 copay a month. I'm taking all these postings with me. Pray pray pray!!
Darryl, 44 w/cf --(DF508 & 3272-26A>G) was dx at 24
Darryl, 44 w/cf --(DF508 & 3272-26A>G) was dx at 24
K
Keepercjr
Guest
<div class="FTQUOTE"><begin quote><i>Originally posted by: <b>jmiller</b></i> Just let us try! </end quote>
That is EXACTLY how I feel. When I had my clinic appt today my doctor was really hesitant but I think I convinced her (she said I can talk to the nurse about getting the script). I had to reiterate that I just want to *try* it for a month to see if it helps. If it doesn't it doesn't but if I an get my insurance to pay for it why not. There really is no way to know that it wil or won't unless I try it. The only variable for me is I am going to get my first shot of xolair next week and she said it would be trying too much at one time (2 new meds) so I wouldn't know which one was helping more. I kind of agree which sucks because I was hoping to get it soon. I think I will ask the nuse to prescirbe it for me and I will agree to wait a few weeks to try it (assuming I can get approved - big assumption). I have a CT scan scheduled for tomorrow and will speak with the clinic again on Friday when I will officialy ask for the 2nd time to get it prescribed.
I'm glad my mind is so focused on preparing my spring/summer garden as I want these meds and I want them NOW. It is hard waiting. But I have other things to occupy myself with thankfully.
That is EXACTLY how I feel. When I had my clinic appt today my doctor was really hesitant but I think I convinced her (she said I can talk to the nurse about getting the script). I had to reiterate that I just want to *try* it for a month to see if it helps. If it doesn't it doesn't but if I an get my insurance to pay for it why not. There really is no way to know that it wil or won't unless I try it. The only variable for me is I am going to get my first shot of xolair next week and she said it would be trying too much at one time (2 new meds) so I wouldn't know which one was helping more. I kind of agree which sucks because I was hoping to get it soon. I think I will ask the nuse to prescirbe it for me and I will agree to wait a few weeks to try it (assuming I can get approved - big assumption). I have a CT scan scheduled for tomorrow and will speak with the clinic again on Friday when I will officialy ask for the 2nd time to get it prescribed.
I'm glad my mind is so focused on preparing my spring/summer garden as I want these meds and I want them NOW. It is hard waiting. But I have other things to occupy myself with thankfully.
K
Keepercjr
Guest
<div class="FTQUOTE"><begin quote><i>Originally posted by: <b>jmiller</b></i> Just let us try! </end quote>
That is EXACTLY how I feel. When I had my clinic appt today my doctor was really hesitant but I think I convinced her (she said I can talk to the nurse about getting the script). I had to reiterate that I just want to *try* it for a month to see if it helps. If it doesn't it doesn't but if I an get my insurance to pay for it why not. There really is no way to know that it wil or won't unless I try it. The only variable for me is I am going to get my first shot of xolair next week and she said it would be trying too much at one time (2 new meds) so I wouldn't know which one was helping more. I kind of agree which sucks because I was hoping to get it soon. I think I will ask the nuse to prescirbe it for me and I will agree to wait a few weeks to try it (assuming I can get approved - big assumption). I have a CT scan scheduled for tomorrow and will speak with the clinic again on Friday when I will officialy ask for the 2nd time to get it prescribed.
I'm glad my mind is so focused on preparing my spring/summer garden as I want these meds and I want them NOW. It is hard waiting. But I have other things to occupy myself with thankfully.
That is EXACTLY how I feel. When I had my clinic appt today my doctor was really hesitant but I think I convinced her (she said I can talk to the nurse about getting the script). I had to reiterate that I just want to *try* it for a month to see if it helps. If it doesn't it doesn't but if I an get my insurance to pay for it why not. There really is no way to know that it wil or won't unless I try it. The only variable for me is I am going to get my first shot of xolair next week and she said it would be trying too much at one time (2 new meds) so I wouldn't know which one was helping more. I kind of agree which sucks because I was hoping to get it soon. I think I will ask the nuse to prescirbe it for me and I will agree to wait a few weeks to try it (assuming I can get approved - big assumption). I have a CT scan scheduled for tomorrow and will speak with the clinic again on Friday when I will officialy ask for the 2nd time to get it prescribed.
I'm glad my mind is so focused on preparing my spring/summer garden as I want these meds and I want them NOW. It is hard waiting. But I have other things to occupy myself with thankfully.
saveferris2009
New member
<div class="FTQUOTE"><begin quote><i>Originally posted by: <b>jmiller</b></i> Caroline- so interesting how things are not quite matching up... it sounded pretty straightforward from how Amy described it.. and yet when I asked my previous dr about it she said I woud likely have to petition Vertex?! Just let us try! I'm going to make my case and call my new dr tomorrow.</end quote>
Why in the world would you have to petition Vertex? That is the most bizarre thing I've ever heard. And it's 100% not true!
Keep trying until you get it.
Why in the world would you have to petition Vertex? That is the most bizarre thing I've ever heard. And it's 100% not true!
Keep trying until you get it.
saveferris2009
New member
<div class="FTQUOTE"><begin quote><i>Originally posted by: <b>jmiller</b></i> Caroline- so interesting how things are not quite matching up... it sounded pretty straightforward from how Amy described it.. and yet when I asked my previous dr about it she said I woud likely have to petition Vertex?! Just let us try! I'm going to make my case and call my new dr tomorrow.</end quote>
Why in the world would you have to petition Vertex? That is the most bizarre thing I've ever heard. And it's 100% not true!
Keep trying until you get it.
Why in the world would you have to petition Vertex? That is the most bizarre thing I've ever heard. And it's 100% not true!
Keep trying until you get it.
saveferris2009
New member
<div class="FTQUOTE"><begin quote><i>Originally posted by: <b>Keepercjr</b></i> jmiller - according to the online info for my script company my copay is $35. I'm trying to get my doctors to prescribe it for me. Get this - the *REP* from vertex told the CF nurse at my clinic that you *can not* get Kalydeco via insurance unless you have the G551d mutation (you would have to pay out of pocket). I told the nurse that he was wrong as I know for a fact that there are some CFers out there currently trying it who don't have that mutation and their insurance covered it.</end quote>
The rep at my CF center told my doc that too.
It's a lie. Straight up lie.
Don't stop 'til you get a script!!!!
The rep at my CF center told my doc that too.
It's a lie. Straight up lie.
Don't stop 'til you get a script!!!!
saveferris2009
New member
<div class="FTQUOTE"><begin quote><i>Originally posted by: <b>Keepercjr</b></i> jmiller - according to the online info for my script company my copay is $35. I'm trying to get my doctors to prescribe it for me. Get this - the *REP* from vertex told the CF nurse at my clinic that you *can not* get Kalydeco via insurance unless you have the G551d mutation (you would have to pay out of pocket). I told the nurse that he was wrong as I know for a fact that there are some CFers out there currently trying it who don't have that mutation and their insurance covered it.</end quote>
The rep at my CF center told my doc that too.
It's a lie. Straight up lie.
Don't stop 'til you get a script!!!!
The rep at my CF center told my doc that too.
It's a lie. Straight up lie.
Don't stop 'til you get a script!!!!
saveferris2009
New member
<div class="FTQUOTE"><begin quote><i>Originally posted by: <b>BleedOrange1968</b></i> Thanks so much for all this info! I am going Friday to my doc. She better get me a script!!! I called Caremark and they cover it for me at an $80 copay a month. I'm taking all these postings with me. Pray pray pray!! Darryl, 44 w/cf --(DF508 & 3272-26A>G) was dx at 24</end quote>
Calmly walk your doc through what the REAL objection is.
So so so often insurance is just a smoke screen for another objection the doctor has.
Does the doc have safety concerns? Does the doc have efficacy concerns?
Dig deep to find out teh REAL objection.
Calmly walk your doc through what the REAL objection is.
So so so often insurance is just a smoke screen for another objection the doctor has.
Does the doc have safety concerns? Does the doc have efficacy concerns?
Dig deep to find out teh REAL objection.
saveferris2009
New member
<div class="FTQUOTE"><begin quote><i>Originally posted by: <b>BleedOrange1968</b></i> Thanks so much for all this info! I am going Friday to my doc. She better get me a script!!! I called Caremark and they cover it for me at an $80 copay a month. I'm taking all these postings with me. Pray pray pray!! Darryl, 44 w/cf --(DF508 & 3272-26A>G) was dx at 24</end quote>
Calmly walk your doc through what the REAL objection is.
So so so often insurance is just a smoke screen for another objection the doctor has.
Does the doc have safety concerns? Does the doc have efficacy concerns?
Dig deep to find out teh REAL objection.
Calmly walk your doc through what the REAL objection is.
So so so often insurance is just a smoke screen for another objection the doctor has.
Does the doc have safety concerns? Does the doc have efficacy concerns?
Dig deep to find out teh REAL objection.
saveferris2009
New member
Of course they won't object to Rx-es being filled for any reason.
The only time a company won't allow this is when each Rx is being tracked by the FDA under a program called a REMS.
Kaly doesn't have this type of REMS, so it can be Rx-ed for any reason <img src="i/expressions/face-icon-small-smile.gif" border="0">
The only time a company won't allow this is when each Rx is being tracked by the FDA under a program called a REMS.
Kaly doesn't have this type of REMS, so it can be Rx-ed for any reason <img src="i/expressions/face-icon-small-smile.gif" border="0">
saveferris2009
New member
Of course they won't object to Rx-es being filled for any reason.
The only time a company won't allow this is when each Rx is being tracked by the FDA under a program called a REMS.
Kaly doesn't have this type of REMS, so it can be Rx-ed for any reason <img src="i/expressions/face-icon-small-smile.gif" border="0">
The only time a company won't allow this is when each Rx is being tracked by the FDA under a program called a REMS.
Kaly doesn't have this type of REMS, so it can be Rx-ed for any reason <img src="i/expressions/face-icon-small-smile.gif" border="0">