I am curious if others have had issues with Anthem BC/BS not covering Ocrevus. It would be a Tier 4 drug if they listed it in their formulary. They do not.
I am lucky to have one of the best neurologists in my state and in the research we have both done, we found Ocrevus to be the best potential pharmaceutical out there for my progression, and the only one which has shown very good results in treating PP MS as well as SP MS.
While Ocrevus is pretty new to the market, just FDA approved in March of 2017, its trial effectiveness was excellent and it was FDA fast tracked and approved. You'd think that an insurance company might want to pick up on this, since without it, the cost to treat the myriad of other MS symptoms would seemingly cost them more in the long run while causing more suffering for their payers. The personal financial burden is potentially devastating for me, though frustration arises when you consider that I am already paying a high dollar figure for an insurance that seems not to care, or want to work with our doctors. Add to it the fact that I am otherwise very healthy and my claims in the past 25 years are a drop on the bucket compared to the cost of my premiums.
For those using Ocrevus, are you finding its benefits to be as good as the trials seem to indicate?
Wow! It is pretty new. My provider's 2017 formulary doesn't even mention it.
My apologies if you have already looked into this but:
Does Anthem have a formal appeal process to include Ocrevus in a better Tier that provides better coverage.
My provider does have a formal appeal process to consider drugs not in their formulary or in a Tier that may not provide adequate coverage. If they do, it's worth a try.
Sometime the company itself will provide some coverage on a short-term basis.
It may be enough for Ocrevus to be mroe out there for your provider to reconsider its tier for next year.
Sorry that I can't provide more solutions. Maybe other posters can.
About a year ago my Anthem BC/BS plan forced me to switch from Rebif (which I had been on 5 years) to Plegridy. After 1 year of that thay are making me switch to Avonex. No relapses over those 6 years. What with all the confuion and lack of communication over the change (Anthem won't answer drug questions, Optum doesn't know why the orders won't go through,and the specialty phamacy Briova thinks that I can't order it through them) I was off any treatment for about 2 months and now am in a relapse.
My neuro checked and Ocrevus isn't covered either. Seems the only thing they cover now is Avonex. I'm still trying to get a formulary list.
When a medication is recently approved it can take some time for insurance companies to add them to the formulary. I encourage you to appeal the denial from your insurance company. You can read more information about health insurance appeals and exception requests at this link.
I also encourage you to contact Genentech for assistance if you have not done so already.Their phone number is 1.844.627.3887 or 1.866.422.2377. Their website is http://www.Genentech-Access.com.
MS Navigator Stephanie
From looking at the formulary for Anthem BC/BS, it is apparent they do not cover many MS drugs at all, much less a new one. I will appeal the rejection. Is there an addendum version of the PDF for Ocrevus?
My neurologist and I have reached out to Genentech and filled out their paperwork for financial assistance. I am still awaiting a response.
I'm looking at this too. One thing to check: because it is administered by infusion in a hospital-like setting, Ocrevus is considered covered as a medical benefit, not pharmaceutical like Rebif. That might be why it is not listed in the formulary and comes up as "not covered" in my ACA application. Our first administration of Ocrevus was approved and completed this year. However, I'm not sure how to confirm this re 2018 and am very concerned.