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Insurance has denied coverage
I've been fighting MF and MDS for a long time. Had a number of different treatments over the years. Some helped more than others, but none of them stopped the progression. Finally my spleen was so enlarged that they had to do something... but at the last minute they tried Vonjo before more drastic measures. It worked! In a short period of time my spleen shrank down, the pain went away and i was able to eat a meal again rather than taking small portions all day long. My counts increased... things were looking better... SO... XXXX sent me notice that since my platelet counts were above 50 now, that they would no longer pay for the drug!!! Seems pretty dumb to me, it's working so you can't have it. I called them but the best I could get them to do was to continue until the end of 2023. The pharmacy at the Cancer Center got me one more bottle, so I now have a little more than a months supply left. I have an appointment with my Dr. in about two weeks. Don't know where we go from here. Nice Christmas present from my Medical Insurance company.
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Try Universal Drug Store in canada. you need a prescription but the prices of drugs are much lower then ours.
I get many of drugs there. Give it a try you might be able to afford it from Canada.
Hope this helps.
TNX for your comment. I used to buy some drugs from Canada, and they were cheaper. But that was before I came down with the Cancer. Vonjo's current full retail price is $35,000 for a one month supply. BCBS was paying just under $25,000 per month. It is a specialty drug. I made contact again with the Prior Approval department at BCBS today and told them I wanted to appeal their decision. The lady I spoke with told me that I didn't need a prior approval for the drug because it is now listed. I will have my Dr. write a prescription for it and see if they will fill it. This is all new. If it is true, then it is part of the "Game" they are playing to shift the cost over to Medicare. A month ago BCBS Federal Employees added Medicare part "D" to their Basic Medical Plan. In the past my Medicare, who is my Primary, didn't cover any of the drug cost. It was all covered by my Secondary, BCBS Federal Employees plan. I sure hope she is correct! I should find out in about a week when I see the Dr. Keep fingers crossed.
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2 ReactionsIf you are sick and need help, you shouldn’t care who’s in the White House. You never know from where your help may come. God still provides. It’s worth a try.
Update on Insurance denial for Vonjo. It has turned out to be as I guessed. In December BCBS FEP added Medicare Part D to their insurance. They pay the part D premium. I was told that it would be supplemental to my existing Drug program, but it appears that they have shifted it over to Part D. Vonjo is on Medicare's Part D list of Drugs. That is the GOOD NEWS. I got it refilled today at the Cancer Center. The bad news is that the coupons that I was using to bring down the copay of the drug are not applicable when using Medicare part D. So... my copay cost has gone up to 3 time what it was. Considering what is at stake, I am more than happy to pay the cost, which is still affordable. Lesson to be learned is to stay on top of not only your medical care, but on top of your insurance too. It is to your advantage to be Pro-active when it comes to your care. Don't get too bossy or irate with anyone. It is much better to keep them on your side rather than to alienate them. Fact is, there is very little that you can do in the short term, so try to stay calm, be polite, and keep sending Knee mail to God. Best wishes to all of you.
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