Tysabri Information & Check In

katty · 01-08-2009, 11:04 PM

Quote:

Originally Posted by lady_express_44

Wow! Thanks for the explanation.

Where given a choice, I would still ask why not CHOOSE the cheapest option?

Cherie

Hi all. My infusion center charges my insurance company $13,000

per infusion. I think it's such a rip off, even though I don't pay anywhere near that amount--my husband and I own our own business, so we buy the insurance for our employees, which means that our group insurance costs are going to skyrocket. I wasn't able to get approved for a cheaper site.

Katty

lady_express_44 · 01-08-2009, 11:27 PM

Quote:

Originally Posted by katty

I wasn't able to get approved for a cheaper site.

Katty

According to who? Your insurance carrier?

If insurance is making that decision, couldn't you appeal it? I am constantly appealing my carriers stupid decisions, and winning.

Are there limitations to which hospitals a person can go to too? I don't know the US system cause I am in Canada ... but was of the impression that a person could at least choose ANY hospital (for the infusion).

I just think that if there is a will, there's a way . . . MOST times anyway.

Cherie

katty · 01-10-2009, 12:14 AM

Quote:

Originally Posted by lady_express_44

According to who? Your insurance carrier?

If insurance is making that decision, couldn't you appeal it? I am constantly appealing my carriers stupid decisions, and winning.

Are there limitations to which hospitals a person can go to too? I don't know the US system cause I am in Canada ... but was of the impression that a person could at least choose ANY hospital (for the infusion).

I just think that if there is a will, there's a way . . . MOST times anyway.

Cherie

I tried to appeal it, but the appeals group couldn't understand the problem--they were paying for the treatment, what did I care how much it cost the insurance company? I live in a town that has one hospital and no separate infusion center so my options are limited. I will eventually try again, to get the infusion done at the neuro's office. I tried this before but the insurance wouldn't approve it even though it would have saved them a boat load of money.

Also, from what I've been told, you have to get the infusion done at a place that's in some way connected to your neuro. Has anyone heard different?

Katty

4boysmom · 01-10-2009, 10:10 AM

The center also has to be TOUCH approved. I live in a town of about 60,000 and we have 3 places to get Tysabri, the hospital, an oncology center, and a home IV pharma place. I go to the home IV pharma place. My primary insurance will not pay for me to go to the hospital. They told me that over the phone.

Where I'm going to run into problems, and it isn't a problem for me, but my infusion center. My primary insurance carrier pays a set amount. My secondary insurance has a deal with the center for a reduced amount. But it is reduced for the reasonable and customary charge, not the set amount of my primary. So they end up losing money on me until my max out of pocket is met from my primary.

The center is going to try and bill different. I hope it works. I don't think they are unreasonable, so I hate to see them lose money!

lady_express_44 · 01-10-2009, 11:15 AM

Quote:

Originally Posted by katty

I tried to appeal it, but the appeals group couldn't understand the problem--they were paying for the treatment, what did I care how much it cost the insurance company? I live in a town that has one hospital and no separate infusion center so my options are limited. I will eventually try again, to get the infusion done at the neuro's office. I tried this before but the insurance wouldn't approve it even though it would have saved them a boat load of money.

Also, from what I've been told, you have to get the infusion done at a place that's in some way connected to your neuro. Has anyone heard different?

Katty

That's incredible, Katty!

I'm glad you have a vested interest in trying to rectify this, and I'll be curious to hear if you ever do.

It almost seems risky to rock the boat though, when you are dealing with corporations where common sense doesn't prevail.

Cherie

Riverwild · 01-15-2009, 09:35 PM

Quote:

Originally Posted by Riverwild

I use an oncology infusion center connected to a hospital.

The debate about the cost also has to take into account that some people's Tysabri is covered under their prescription plan. Some people have it covered under major medical with the infusion center supplying the drug. Some physicians supply the drug.

The cost of the drug when it is associated with a middleman is a doubling in cost. There are only so many pharmacies that you or the infusion center can order Tysabri from. So when the insurance prescription plan orders from the supplier, they pass some cost on to your plan. When the infusion center orders through THEIR supplier who orders through the central pharmacy that is TWO adds to the cost. They pass that cost on to you or your insurance plan. If the doctor orders the drug through his supplier who orders it through their supplier who orders it through the central pharmacy, and supplies it to the infusion center...

Addition for more information on pharmacies and Tysabri:

" TYSABRI became commercially available in the US in July 2006. Under the TOUCH Prescribing Program, only prescribers, infusion centers, and pharmacies associated with infusion centers registered in the TOUCH program are able to prescribe, infuse or distribute TYSABRI. Elan has contracted with a single distributor, ICS, a division of AmerisourceBergen Specialty Group, and 12 specialty pharmacies: Caremark, CuraScript, PharmaCare, PrecisionRx Specialty Solutions, Medmark, BioScrip, McKesson Specialty, Option Care, Cigna Tel-Drug Specialty Pharmacy, Aetna Specialty Pharmacy, Prescription Solutions, and Accredo NovaFactor. ICS and the 12 specialty pharmacies have been trained on the TOUCH Prescribing Program and are obligated to follow the requirements of the program in order to purchase and distribute TYSABRI to authorized infusion sites and central pharmacies."

http://prohostbiotech.com/stocks_det...ck_id=elan-eln

Curious · 01-15-2009, 10:17 PM

Howdy Howdy.

Just an FYI, this thread is getting close to the 1000 post mark. AWESOME!

Someone let me know when you are at a good point to start #2. Both will be in the stickies.

Curious

Riverwild · 01-16-2009, 06:52 AM

How time flies when we're having fun!

Let's change at 1000! Nice round number and it sounds lucky!

laurasari · 01-16-2009, 08:44 AM

katty

I dont think the dr has to have an association with the infusing dr. Although mine spoke with my initial dr he does not have any other of his patients and they dont work out of the same hospital. Ibelieve he said they have never met. They are not located in the same town.

I have had 2 infusions in NJ and 1 so far in Fl. TOUCH program helped me get into the one in fl. You can xall then abd see if they can help.

Good luck

laurief

Curious · 01-16-2009, 09:42 AM

Quote:

Originally Posted by Riverwild

How time flies when we're having fun!

Let's change at 1000! Nice round number and it sounds lucky!

NO ONE post when the count is 1000. PM me to notify me.

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