whats the next step if Tecfidera is not covered by my BCBS?
 

Just spoke to a lady at my express scripts representing my blue cross blue shield and she said Tecfidera will not be covered.

What happens now?

Sorry to hear this, Karilann. But not to worry. Biogen has a patient support system which offers financial support. Call MSActivesource at 1-800-456-2255 to see how to get the ball rolling.

Good luck!

Have you ever been on another MS medication? If so, I do not understand why BCBS wouldn't approve. I am on day 6 of Tecfidera; I too have BCBS and didn't have ANY problems at all.
I would give a call to them and ask for re-consideration.
Wish you the best, I am praying that THIS is the the med that works for so many!

I had trouble years ago with BCBS... Put on my best snotty voice, called, and asked "Are YOU denying me medical care?" Not angry (no one listens then), just an edge of astonishment and disbelief. Maybe that helped. Who knows. Got what I wanted. I guess it depends who you talk to. Don't give up!

Sometimes dealing with health care insurance companies is like trying to nail Jello to trees.

Not sure if MS Active Source will let me in on their $10 co-pay plan due to the fact that I have Medicare. That's one of their stipulations....you can't have Medicaid/Medicare/ VA etc.
I do not carry Medicare Prescription Plan however. Just the A & B.

I will call back Blue Cross. I see online with the mail order pharmacy that we use, that they list the drug as a "Not Covered". Perhaps in the future they will.
Otherwise I can have my doc fill out an "exception form" and try and get them to re-consider.
It just frustrates me because they are making me go through red tape. :(

UPDATE! Just spoke to Blue Cross and Blue Shield 5 mins ago and its COVERED! They must have just changed it! Anyway, I will have to pay a little higher co-pay because its not in a "preferred group of drugs", and I have to make sure I buy it mail order only or I will have to pay 45%. WHEWWWWWWWWWWW!

I just got a letter from Humana , and they will not cover this drug for me either. The letter stated I could not question their decision, so I am in the same boat with this drug. No coverage, and no shot at the $10 co-pay!

Yay for you, Karilann!

So sorry Bluenurse.

Bluenurse, try calling MSActivesource directly to hear their options. The number is above.