Medicare no longer will cover two boxes of Pulmozyme a month was told its "To expensive?"

[carly23]

Medicare no longer will cover two boxes of Pulmozyme a month was told its "To expensive?"

I was informed today that medicare no longer will cover pulmozyme two boxes anyway because of the cost?...im blown away what do they expect me to do?..they will only allow one refill a month..i do pulmozyme twice a day..anyone ran into this problem to?..this is frustrating why is there a change?

 

[carly23]

Medicare no longer will cover two boxes of Pulmozyme a month was told its "To expensive?"

I was informed today that medicare no longer will cover pulmozyme two boxes anyway because of the cost?...im blown away what do they expect me to do?..they will only allow one refill a month..i do pulmozyme twice a day..anyone ran into this problem to?..this is frustrating why is there a change?

 

[JustDucky]

Medicare no longer will cover two boxes of Pulmozyme a month was told its

I have not had this problem with my pulmozyme, but then again, I only take it once a day. That's why they are probably not covering it, you have BID dosing. What I would do, is appeal it. Have the social worker at your CF clinic help you out, perhaps a letter of necessity from your doctor will help you get the two boxes a month covered.

Good luck,
Jenn 40 wCF

 

[JustDucky]

Medicare no longer will cover two boxes of Pulmozyme a month was told its

I have not had this problem with my pulmozyme, but then again, I only take it once a day. That's why they are probably not covering it, you have BID dosing. What I would do, is appeal it. Have the social worker at your CF clinic help you out, perhaps a letter of necessity from your doctor will help you get the two boxes a month covered.

Good luck,
Jenn 40 wCF

 

[MCGrad2006]

Medicare no longer will cover two boxes of Pulmozyme a month was told its

Ask your doctor or nurse coordinator. I had that problem, my enzymes were not covered, so I had to switch and the new ones didn't work...so then my nurse at clinic was able to right a letter to insurance to cover the old enzymes.

 

[MCGrad2006]

Medicare no longer will cover two boxes of Pulmozyme a month was told its

Ask your doctor or nurse coordinator. I had that problem, my enzymes were not covered, so I had to switch and the new ones didn't work...so then my nurse at clinic was able to right a letter to insurance to cover the old enzymes.

 

[Giggles]

Medicare no longer will cover two boxes of Pulmozyme a month was told its "To expensive?"

I was told by my pharmacy that Medicare only covers 30 day supply of drugs. So with Pulmozyme make sure the script is written or called in for a 30 day supply. have it written for inhale 2 ampules daily for 30 days for a total of 60 ampules. I think they just have to word it that 2 ampules daily IS a 30 day supply for you. Hopefully it just has to do with the wording and you will be able to get the quantity you need. Can not just say 2 boxes and take as directed. Have them SPELL it out that your needs are twice a day for 30days. Hopefully that should work and you will get your 2 boxes. I hope so!!!! Good luck!

 

[Giggles]

Medicare no longer will cover two boxes of Pulmozyme a month was told its "To expensive?"

I was told by my pharmacy that Medicare only covers 30 day supply of drugs. So with Pulmozyme make sure the script is written or called in for a 30 day supply. have it written for inhale 2 ampules daily for 30 days for a total of 60 ampules. I think they just have to word it that 2 ampules daily IS a 30 day supply for you. Hopefully it just has to do with the wording and you will be able to get the quantity you need. Can not just say 2 boxes and take as directed. Have them SPELL it out that your needs are twice a day for 30days. Hopefully that should work and you will get your 2 boxes. I hope so!!!! Good luck!

 

[bluevelvet73]

Medicare no longer will cover two boxes of Pulmozyme a month was told its "To expensive?"

I had problems getting Pulmozyme because my Medicaid benefits took so long to be approved. Call or check online the Parmaceutical 'Genentec'. I only require 1 box a month but they have been provideing me with this much needed medicine for 2 years.
Please follow the instructions from the link. I hope this is helpful!!

http://www.genentechaccesssolutions.com/portal/site/AS/

 

[bluevelvet73]

Medicare no longer will cover two boxes of Pulmozyme a month was told its "To expensive?"

I had problems getting Pulmozyme because my Medicaid benefits took so long to be approved. Call or check online the Parmaceutical 'Genentec'. I only require 1 box a month but they have been provideing me with this much needed medicine for 2 years.
Please follow the instructions from the link. I hope this is helpful!!

http://www.genentechaccesssolutions.com/portal/site/AS/

 

[KyleFoundationCare]

Medicare no longer will cover two boxes of Pulmozyme a month was told its

I work for a CF Pharmacy, and deal with the appeals for our twice daily pulmozyme patients. Medicare Part B is very restrictive and requires specific information before approval. And even with those, each Region(there are 4) treats the information differently. Here is what we send our physicians when we recieve a script for twice daily pulmozyme.

Medicare suggests the following information be included in a letter of medical necessity:

1. Documentation clearly documents other treatments tried/failed/discontinued and why
2. Documentation clearly documents other treatments currently using along with the Dornase alpha
3. Documentation supports significant improvement with two doses vs the one dose
4. Clearly documents limited pulmonary improvement with only once per day dosing
5. Clearly documents pulmonary improvement (objective data) and shows the difference from once per day to twice per day, that includes:
a. Spirometry on once and twice a day dosing
b. Forced Vital Capacity (FVC) on once and twice a day dosing
c. Mean improvement in Forced Expiration Volume (FEV1) on one and two doses per day