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    • #21361
      Karla Wood
      Participant

      So I will do my best to make this short.  So my boyfriend was on Tecfidera and his Insurance switched him to the generic version Dimethyl Fumarate. When he went to the pharmacy to fill it they wanted him to pay $4000 a month.  Spent a ton of time of time on the phone with the pharmacy, insurance and Biogen (maker’s of Tecfidera).  Biogen said they would help pay for Vumerity if the insurance company would also help. Of course, the insurance company said won’t and Biogen can only help so much.  We talked to insurance again and they said he should have a $30 co-pay on the Dimethyl Fumarate and that they would straighten it out with the pharmacy. Well they called us back today and now are saying they want $1300 a month.  We can’t afford that, we are struggling as is.  He is still working but makes too much to qualify for any financial assistance programs (we are right on the edge-of course) and he is not old enough to qualify for Medicare or Medicaid (He’s 50).  We are stuck and he is out of medication.  Any advice regarding which insurance companies will cover MS medication? Extra note: he will not do injections so those medications are pretty much out.

       

    • #21369
      Ed Tobias
      Keymaster

      Hi Karla,

      I’m sorry for all of the problems your and boyfriend are having with the co-pay. Have you asked the insurance company to place a conference call to the pharmacy, with you on the call, to try to straighten things out verbally? Or, you might try asking the insurance company to send you an email stating that the co-pay is only $30. Have you tried asking to speak with a supervisor at the pharmacy to explain the problem. Finally, you might try Biogen’s customer service people again and see if they could help mediate between the pharmacy and the insurance folks.

      Good luck and please let us know how it goes.

      Ed

      • #21370
        Karla Wood
        Participant

        Yes we have tried all of it.  Spent over 3 hours on the phone Monday with Insurance and CVS, they just keep contradicting each other. I think we just need to find new insurance.  I have spoken to some other people that have specialty drugs who also have the same insurance and pharmacy and they are having issues too.

         

    • #21376
      Ed Tobias
      Keymaster

      Karla,

       

      One last thought. If you think the problem is with the insurance side, rather than with CVS/Caremark, you might want to contact your state’s insurance commission and explain the problem to them. Most insurance companies react to pressure from their state regulators.

      Ed

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