Here we go again. Another battle with the insurance. After I went to through the the battle with them and filed every appeal possible for my Rituxan, I was denied. Insurance denied saying it was not approved for multiple sclerosis. Although we filed all the necessary paperwork and they did approve it for others they would not approve it on my case. What is more than frustrating and this is that the new drug that is coming out for MS, Ocrelizumab is basically Rituxan. See this post for the comparison https://multipleexperiences.org/2017/01/12/ocrelizumab-versus-rituximab-rituxan/.
I was able to get a grant through the company that makes Rituxan so I can receive the medicine. http://www.rituxan.com/hem/patient/rituxan-patient-assistance
I made the error of thinking I solved the problem. When I sat down for my infusion a few weeks ago my first question was, has all the authorizations gone through? I was told yes, otherwise you wouldn’t be sitting here. Well the other day I received a denial from my insurance in the mail. .
The insurance company is still denying the Rituxan. Hello, I didn’t ask you to pay for the Rituxan. You are paying for an office visit infusion of medicine steroids (which is covered), benedryl (covered), oh and saline. The medicine isn’t up for your decision anymore. Although thank you for telling me what I’m allowed to try. Would you like to tell me if I should choose life or choice too? Didn’t I take care of my part taking action getting the drug I want covered? I did the right steps for the office visit to be covered. I saw my primary physician got the necessary authorization to go to this office and be treated…what is the issue? Once again a battle with the healthcare. More amazing is the cost of Rituxan per year is about $25,000 less than Tysabri and many other MS drugs. Again the drug isn’t even being billed to my insurance just the infusion cost. Another way the big bad insurance company wins, on a technicality. I should sue for the stress the insurance company has caused me over the last year. My 3rd battle with them in less than 8 months. FREAKING RIDICULOUS!!!