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Avonex - no longer on Preferred Formulary

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Old 03-02-2009, 02:44 PM #1
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Question Avonex - no longer on Preferred Formulary
My Avonex copay went from $50/month in 2008 to $100/mo in 2009 because Avonex is no longer on the Preferred Formulary. That's $600 more a year, so $1200. I know, I know.... at least I have insurance.

I never found out WHY Avonex was no longer on the Preferred Formulary.... anyone know?
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Old 03-02-2009, 04:55 PM #2
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It could just be your insurance. My insurance does that from time to time. It does suck.
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Old 03-02-2009, 06:19 PM #3
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It could just be your insurance. My insurance does that from time to time. It does suck.
I recall the insurance company said something about following what Medicare or Medicaid allows.... which has nothing to do with the insurance I have, but obviously something Aetna follows. For the lower copay, I could switch to either Copaxone, Beta-Seron, or Rebif. However, my neurologist preferred I stay what I am doing well on. Why rock the boat?
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Old 03-03-2009, 08:05 AM #4
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Your MD can petition your insurance company and request help with that. I am not sure how all of it works, but when I was doing heavy chemo, my insurance company dropped one of the meds that worked very well for me, off of the formulary. My MD petitioned them, and they returned it to the forumlary. If no one speaks up, they will not bring it back. The more that speak up, the more pressure they will feel. If your MS center takes care of alot of folks on your type of insurance, it may benefit many, not just you.
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Old 03-03-2009, 08:18 AM #5
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Your MD can petition your insurance company and request help with that. I am not sure how all of it works, but when I was doing heavy chemo, my insurance company dropped one of the meds that worked very well for me, off of the formulary. My MD petitioned them, and they returned it to the forumlary. If no one speaks up, they will not bring it back. The more that speak up, the more pressure they will feel. If your MS center takes care of alot of folks on your type of insurance, it may benefit many, not just you.

That's quite interesting. I can still get the Avonex, but I have the higher copay. <Argh!>
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Old 03-03-2009, 01:23 PM #6
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Carry - after reading your post, I checked our Aetna plan. Thankfully ours still has Avonex listed as a $20 co-pay. Just one more reason for my DH to be thankful of where he is working and to appreciate his employer. But I am waiting for that co-pay to go up any day now...I'm sure it will soon.
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Old 03-03-2009, 01:35 PM #7
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I know my insurance will cover a non preferred if other meds have proven not to work. You doctor fills out a form. At least that's how it goes with my insurance.
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Old 03-04-2009, 01:20 PM #8
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Some insurances have gone public and stated that they are
making BIOLOGICALS fourth tier. This means they will still cover them, but there will be more copay to donate by the patient.

The beginning of this was in 2008, so it stands to reason that
others are following now.

This includes other biologically derived drugs, like Remicade,
Humira etc.

You should call your insurance and find out for sure if this or another reason has been applied.
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