Kalydeco - insurance approval?

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Tom

New member
Has anyone attempted to get Kalydeco approved by their insurance company? We are going to my son's clinic appointment tomorrow and will be discussing Kalydeco. I called Vertex and downloaded a form that the doc needs to fill out and fax to Vertex.
I am nervous that my insurance company will deny the drug or only pay a small portion due to a prescription drug annual benefit maximum.
 
T

Tom

New member
Has anyone attempted to get Kalydeco approved by their insurance company? We are going to my son's clinic appointment tomorrow and will be discussing Kalydeco. I called Vertex and downloaded a form that the doc needs to fill out and fax to Vertex.
I am nervous that my insurance company will deny the drug or only pay a small portion due to a prescription drug annual benefit maximum.
 
T

Tom

New member
We met with our CF team today and they will be moving forward with CF Services Pharmacy to get insurance approval.
 
T

Tom

New member
We met with our CF team today and they will be moving forward with CF Services Pharmacy to get insurance approval.
 
C

CFRacer

New member
I am waiting on the medicine myself. I was told that in 5 weeks (as of 2/7/12) the drug will come out to pharmicies. Hopefully my insurance as well as many others, will be approved to have the drug taken and covered.

I have a personal belief that with all the good that this drug will help us with the specific gene it targets, we could potentally have a cure in maybe 5 years or something. HOW I HOPE!
 
C

CFRacer

New member
I am waiting on the medicine myself. I was told that in 5 weeks (as of 2/7/12) the drug will come out to pharmicies. Hopefully my insurance as well as many others, will be approved to have the drug taken and covered.

I have a personal belief that with all the good that this drug will help us with the specific gene it targets, we could potentally have a cure in maybe 5 years or something. HOW I HOPE!
 
B

BikerEd

Guest
I'm waiting to hear I'm working with my clinic and vertex to see what my insurance will pay and then what copay will be .. vertex has a program called GPS to help navigate the insurance side. JoAnn what insurance do you have?
 
B

BikerEd

Guest
I'm waiting to hear I'm working with my clinic and vertex to see what my insurance will pay and then what copay will be .. vertex has a program called GPS to help navigate the insurance side. JoAnn what insurance do you have?
 
J

JoAnn

New member
Express scripts and it comes from their specialty pharmacy which also provided it for studies so they had it in stock. It too about 3 weeks from the time we talked with clinic, then vertex, then the pharmacy and then in a few days after that - delivery. Best wishes.
 
J

JoAnn

New member
Express scripts and it comes from their specialty pharmacy which also provided it for studies so they had it in stock. It too about 3 weeks from the time we talked with clinic, then vertex, then the pharmacy and then in a few days after that - delivery. Best wishes.
 
S

saveferris2009

New member
I know a handful of people now who have Kalydeco covered by insurance at a reasonable co-pay and no insurance hassle.

And they don't have G551D.

So have hope! You never know with insurance until you try....
 
S

saveferris2009

New member
I know a handful of people now who have Kalydeco covered by insurance at a reasonable co-pay and no insurance hassle.

And they don't have G551D.

So have hope! You never know with insurance until you try....
 
S

semperfiohana

Guest
JoAnn I am just wondering what pharmacy is actually filling the Kalydeco for you? I use express scripts for everything except Colistin and the Kalydeco. I've ordered those through Foundation Care. Is that who you are using?
 
S

semperfiohana

Guest
JoAnn I am just wondering what pharmacy is actually filling the Kalydeco for you? I use express scripts for everything except Colistin and the Kalydeco. I've ordered those through Foundation Care. Is that who you are using?
 
T

Tom

New member
Once I submitted the paperwork to Vertex, my son received Kalydeco within a week. Vertex received the approval from my insurance company within two days and then sent the prescription to CF Services Pharmacy and it was filled within two days and then shipped overnight. My insurance has a $60 copay for 30 days supply which Vertex applied $45 copay assistance. Kalydeco has the smallest out of pocket cost for me out of all of my son's CF drugs.
 
T

Tom

New member
Once I submitted the paperwork to Vertex, my son received Kalydeco within a week. Vertex received the approval from my insurance company within two days and then sent the prescription to CF Services Pharmacy and it was filled within two days and then shipped overnight. My insurance has a $60 copay for 30 days supply which Vertex applied $45 copay assistance. Kalydeco has the smallest out of pocket cost for me out of all of my son's CF drugs.
 
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