I think I posted this on the wrong forum earlier.
Hi I just joined this because I saw marcjo had a the same issue as me. I have been on Kalydeco for 8 months and the company I work for changed insurance companies (from Oxford to Cigna) and Cigna will not approve the Kalydeco for me because I don't have G551D. My doctor and I put an appeal in which was then denied and then the final stage is the peer to peer review which took place last night between my doc and Cigna's Medical Director. I saw this post about the peer to peer review getting approved so I thought I would. However, I was denied eventho my doctor said the medical director was knowledgeable about CF and was going to approve it. I am very very upset (pretty much flipping out) and I will not stop until this is approved. Has this happened to anyone else and what else can I do to get this approved? Does anyone know what was the procedure after the Medical Director approved it, is their someone higher than that? I am not going to stop calling Cigna until I get an answer on this.
Anyway a little history on me, I was diagnosed with CF at 16, I am now 26, my mutations are R347P and L1065P (both very rare). Does anyone else have these mutations?? R347P is class 4 gating mutation and I googled L1065P and only found one case of it in Southern Italy and the patient had mild CF. I am mild CF and pancreatic sufficient. My pfts range from 75% - 81% for the past 3 years. I run 4-5 times a week and work a full time job, I try not to let CF control my life.
After being on Kalydeco I have improved my lung function slightly, I wake up in the morning with no gross thick dark mucus to cough up, and my sweat chloride went from 95.9 to 85 (still not normal, but this was after only 2 months on it, I haven't redone it). But while being on Kalydeco I am able to live a better qualtiy of life and do my vest less and I am currently on no other meds. I definitely see an improvement and have the documents to prove it to the insurance company. Please any advice/feedback would be greatly appreciated!
Thanks!