Insurance refusing Entocort, says not FDA approved

[tex]

Karen,

The letter looks good in general, but 2 things come to mind:

1. Is there a chance that with this history they could exclude coverage based on a claim that this is a pre-existing medical condition?

2. MC is not a rare disease. It's at least as common as Crohn's disease, and it's roughly 60 % more common than celiac disease.

Tex

[mcardle3]

Karen,

The letter looks good in general, but 2 things come to mind:

1. Is there a chance that with this history they could exclude coverage based on a claim that this is a pre-existing medical condition?

2. MC is not a rare disease. It's at least as common as Crohn's disease, and it's roughly 60 % more common than celiac disease.

Tex

Thank you for your help.

1. According to Obamacare I think all pre existing conditions elements of any insurance are now moot.
http://obamacarefacts.com/pre-existing-conditions/

2. I will alter the letters to reflect the information you shared. When I read about it on-line it is often referred to as rare.

Thank you again!

[tex]

I wasn't sure if that clause in the bill (about pre-existing conditions) had taken effect.

Here's what you should be reading (instead of the competition ), and note that references to the data are listed below the article.

http://www.microscopiccolitisfoundation ... lence.html

But yes, until we came along, it was traditionally treated as a rare disease by the medical community, and that's why it was rarely diagnosed.

Tex

[mcardle3]

I wasn't sure if that clause in the bill (about pre-existing conditions) had taken effect.

Here's what you should be reading (instead of the competition ), and note that references to the data are listed below the article.

http://www.microscopiccolitisfoundation ... lence.html

But yes, until we came along, it was traditionally treated as a rare disease by the medical community, and that's why it was rarely diagnosed.

Tex

Look at me learn. I've yet to touch the hem of the garment where this site is concerned. I'm adding this to my stack of info to send to the insurance clan.

[mcardle3]

UPDATE

I sent in my packet to the insurance company today and was beginning to feel quite good about all that I sent. I thank each and every one of you who encourage me daily.

I will admit it got my Scots up and once I have decided I need to work toward something it is hard for me to stop until I achieve some modicum of success.

This morning, my HR department contacted me to let me know that my letter and documentation had been forwarded to our benefits broker, as well as the insurance company. "Good," I thought. They'll get MY packet tomorrow, and I know my doctor has this as a priority for her office.

2 hours later, I get a call...from my insurance company on my office line. I have never given them my office line. We are having a very big foreign dignitary on campus next week and I thought it was perhaps some big wig from the insurance company calling to RSVP.

I answered the phone "office of the president" and hear a lady ask for me! She was calling to let me know that they had received a packet from my HR department through our broker and were reviewing it. That my doctor has told them I am a priority and that I will remain one until I get help. She told me that they hadn't denied the claim but are looking more thoroughly into it.

I told her my packet included information on the benefits of Budesonide on LC and that this really needed to be addressed and Tex, she said to me...your disease is quite rare so our pharmacists who decide what drugs we dispense (shouldn't a doctor be doing that?) have not got the information they need to consider this due to its rare status. Uhm...really?

So a woman who has this illness can find this information out (with a little help from her friends) but their pharmacists cannot?

Egads...but let us all happy dance and keep those fingers crossed for me.

She said that all they actually needed was on study that showed that budesonide worked on MC and it would likely sail through. Here's hoping, my friends!

[tex]

So a woman who has this illness can find this information out (with a little help from her friends) but their pharmacists cannot?

MC has historically been considered rare because you have to intentionally look for it to find it (so if you don't look for it you can't find it). That's a self-fulfilling prophecy that describes why it mistakenly continues to be considered "rare".

She said that all they actually needed was on study that showed that budesonide worked on MC and it would likely sail through. Here's hoping, my friends!

Then approval should be a done deal, once they review your information packet.



Tex

[mcardle3]

Here's hoping!

If you were anywhere near I'd squeeze you til you squeaked for all your help, guidance and encouragement.

[cluesmom]

Anyone know approximate cost of budesonide through Canadian pharmacy per month? My medicare advantage would not pay a cent and out of pocket cost prohibitive. Thanks

[tex]

I'm guessing it will be about $69.50 per month (in U.S. Dollars) these days (plus shipping). I reached that figure by adding a 40 % markup to the current price at the Indian pharmacy that most members here use if they don't have insurance or can't afford the copay.

Tex

[Lilja]

This is so confusing. How can the same prescripiton medication be so expensive in one country, and so inexpensive in another?

What mecanisms make the same product from the same producer almost inaffordable in for example the U.S. and quiite affordable in my country?

I bought 100 capsules of Entocort 3mg in January, the real Entocort from AstraZeneca, at price of $ 50. And this medication was not subidized from any health program. I paid for it right out of my pocket.

Oh! How I hate the pharmaceutical industry

Lilia

[tex]

Lilia,

In most countries, government regulations prevent price gouging by drug companies. But in the U. S., they are free to charge what they want. And when the "Affordable Care Act" was passed, the administration convinced the pharmaceutical and insurance companies to support the legislation by guaranteeing that they would be allowed to continue to do so under the new law. So they charge whatever they want, and naturally the prices continue to increase almost every time we go to get a prescription refilled.

And it's not just expensive-to-produce drugs that are outrageously priced. A couple of years ago I was paying 20-something dollars for a month's supply of Metanx. I picked up a refill a few weeks ago, and compared with the old price, the price has more than tripled. The pharmaceutical companies could afford to give away medications free of charge in other countries if they wanted, because they make such outrageous profits in the U. S.

Tex

[Grahm]

Tex,

I'm now paying $140. a month for the Metanx. Can we get it in Canada or somewhere else?

Thanks,
Connie

[JFR]

Tex,

I'm now paying $140. a month for the Metanx. Can we get it in Canada or somewhere else?

Thanks,
Connie

Instead of buying prescription Metanx you can get the individual vitamins over the counter for less. You can find it discussed in this thread:

http://www.perskyfarms.com/phpBB2/viewt ... ght=metanx

Jean

[tex]

Connie,

The Canadian pharmacy I checked charges approximately what I paid, $230-something for 90 capsules. I sometimes use the alternative that Jean mentioned, but I agree that it's so much more convenient to take a single capsule than to have to remember how many of this pill and how many of that one I need to take to make up a dose.

AllDayChemist doesn't list Metanx, but I just now sent them an email requesting it. We'll see if they can come up with a source. I'll let you know if/when I receive a response.

You're most welcome,
Tex

[tex]

Connie,

I received a response from AllDayChemist, the main line of which said:

We are sorry to inform you but this product is not available.

So that option obviously doesn't exist, unfortunately.

Tex