Transplant: Med change due to insurance change

Posted by hello1234 @hello1234, Jan 18 6:52pm

Hi all 😊
I am on COBRA from my previous employer and now I need to purchase insurance on the ACA Marketplace website because I am not 65 years old yet (Medicare). The insurance plans do not appear to cover my daily Envarsus XR immune suppression med and my insurance agent said I may have to change my medication. I hate the idea after almost three years post transplant to change an immune suppression med that's working well because the insurance company wants me to change (not my doctor).
Has anyone been in this situation of changing a med due to insurance? What did you do?
Thanks everyone!

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Hi @hello1234 That’s really unfortunate having to change insurances and potentially forced to switch meds. I’m not really familiar with to do in that case but when I’ve had issues in the past, where there has been a potential issue with having insurance approval of meds, I called and spoke directly with the insurance provider. One med was extremely expensive and my doctor also wrote a letter giving a case for why this med was imperative. It was approved without further issue.
Give it a try!

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Excellent advice, thank you @loribmt 😊 It's extremely stressful to change insurance plans and potentially have my important immune suppression meds changed after three years. I like your idea of getting my doctor involved to write a letter…Thank you!

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In the mean time while you are trying to get coverage, have you tried the good RX coupons, there is an app for it and drastically cuts the price of medications I take one that's over $3,000 a month and believe it or not Good RX cuts in down to $17.00 at Costco
Hope this helps a little

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@hello1234, I'm sorry to hear about that your new insurance carrier may not cover your Envrasus XR med and how important it is to stick to a medication that has been working well for you! If your provider is unable to convince your new insurance to get you the coverage here is the Envarsus XR manufacturer website that offers a $0 copay. I think it works only if you have commercial insurance. I didn't look into it in details but it's something you may want to consider if insurance won't cover.
Website : https://www.envarsusxr.com/savings-support/envarsus-xr-co-pay-card/
Good luck!
P.S. I hope your battle with BK has resolved!!

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@caretakermom

@hello1234, I'm sorry to hear about that your new insurance carrier may not cover your Envrasus XR med and how important it is to stick to a medication that has been working well for you! If your provider is unable to convince your new insurance to get you the coverage here is the Envarsus XR manufacturer website that offers a $0 copay. I think it works only if you have commercial insurance. I didn't look into it in details but it's something you may want to consider if insurance won't cover.
Website : https://www.envarsusxr.com/savings-support/envarsus-xr-co-pay-card/
Good luck!
P.S. I hope your battle with BK has resolved!!

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Hi @caretakermom 😊
So great to hear from you! Thank you for your excellent suggestion and link to the Envarsus' manufacturer's information. I am going to contact them after lunch. I will keep you posted. Unfortunately, my stubborn BK is hanging on and refusing to turn negative. But the good news is that it's definitely less than it was. Hopefully, in the next month or two I will be able to announce that it's gone!! How is hubby doing? What was decided regarding Everolimus and the proteinuria? Did the level turn out to be low in the lab work? I hope you are doing well and feeling good!
Thank you again for the awesome link! 😊

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@hello1234

Hi @caretakermom 😊
So great to hear from you! Thank you for your excellent suggestion and link to the Envarsus' manufacturer's information. I am going to contact them after lunch. I will keep you posted. Unfortunately, my stubborn BK is hanging on and refusing to turn negative. But the good news is that it's definitely less than it was. Hopefully, in the next month or two I will be able to announce that it's gone!! How is hubby doing? What was decided regarding Everolimus and the proteinuria? Did the level turn out to be low in the lab work? I hope you are doing well and feeling good!
Thank you again for the awesome link! 😊

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Hi @hello1234, please see my response in the Proteinuria thread that I started.

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Hi @bobinnevada 😊
Thanks so much about the heads up regarding Good Rx. I will definitely check it out! I really appreciate knowing that I have some options for staying on my medication. It's great to meet you!

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I started taking Jakafi last fall but my ACA insurance decided not to cover it in 2023. My doctor wants me to stay on it for another three months, so his pharmacy got a grant for me to cover the cost ($10,000)! Maybe you can ask your Cancer Center pharmacy if they can help with this issue.

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@edb1123

I started taking Jakafi last fall but my ACA insurance decided not to cover it in 2023. My doctor wants me to stay on it for another three months, so his pharmacy got a grant for me to cover the cost ($10,000)! Maybe you can ask your Cancer Center pharmacy if they can help with this issue.

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Hi @edb1123 😊
It is very nice to meet you! Thank you so much for sharing your success story! I will definitely keep that idea in mind. My Envarsus XR is an immune suppression med for my kidney transplant so I could reach out to my transplant team for ideas. My insurance agent called me this morning and she is trying to find another plan for me to look at. I will keep you posted….
Thanks again for jumping in!

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Question while we r I. Insurance I am being FORCED to go on MC at 62 y/o. My Insurance premiums will be over 500. a month. The Rx plan which u have to have to not get a penalty is 28. mth. But I will have to pay for my immunosuppressants which right now I have not had to pay much due to the coupons. U r NOT eligible for coupons if u r in MC. “Really” I think that is ridiculous, if I would have had my LTP w/MC they would pay for my meds.
Good Rx is very expensive for my meds.
I am hoping my TPteam will be able to help me if not I don’t know what I will do.. I think this is so wrong for TO patients..
Very frustrating!!!

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