Obtaining approval for Xiaflex -- long frustrating process ?

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kingprof

Hi All, 58-year old man, have had Peyronie's for about 3 months now. Saw urologist and got blood work, ultrasound. My plaque is not calcified so he recommended Xiaflex.
The process to get approval is now going on 6 weeks. Don't want to name companies in this post, but if you're getting Xiaflex in the U.S., it looks like there's really only one game in town. Anyway, I've called a few times
and I really don't get any information from the other end except "we're working on getting approval" Anyone else had this experience with getting Xiaflex approval in the U.S.? Does it normally take this long? I have Blue Cross Blue Shield PPO so I thought insurance wouldn't be a problem.
58 yrs old, 45 degree bend to the left, noticed Peyronie's first in April, 2018. Three rounds of Xiaflex.

Stabler

Hello Kingprof,

Xiaflex is considered a specialty medication your insurance plan requires an authorization so that they will pay. Your urologist office should be working on this for you, they are equipped to handle all the forms and required records. Depending on your plan they may want you to try and fail other medications first or the urologist may need to write a letter of medical necessity and send with your records such as your ultrasound and office notes. It is not unusual for the turn around time to be 30-60 days again depending on the ins plan you have. If the plan is waiting on records from the urologist they won't look at the case until they receive them you should touch base with the urologist office to see if they have sent all necessary records and THEY should be following up on the case not you. If you have been calling the insurance company you are only talking to member services the urologists office will be talking to the pre-certification department that handles the approvals for specialty meds. Member services will be of no help in this matter.

I am happy to answer any questions you may have on this, this is what I do for a living so please feel free to pM me if you want to.

Stabler67
Moderator since 2015- Missouri- I work in the medical field and have strong knowledge of insurance and how to obtain coverage for medication and other treatments. Being a woman I do not have Peyronies but you can ask me anything. I am happy to help.

Perceptible Curve

Yes. Took about 2 months total for my approval. It needs to go through different levels of approvals. If it was denied at some point they should reapply for you and will take more than 7 days up to a month. Once the prescription goes to the specialty pharmaceutical like US Bioservices, they contact your insurance and figure how much they cover, (in my case Blue Cross PPO was free. Thank You BCBS) or it could take a bit longer if your insurance co. won't cover 100 % they will find an assistance program that may cover what insurance won't. I hear this program helps a lot and could theoretically add to the wait time . They then call you and get additional info and get your approval to ship the vials to your doctors office. Hope this helps. Good luck.
And of course come back here and make an online diary and tell others of your experience good or bad.
Age: 54.
Onset of Peyronies ~16 years ago.
~45 Degree bend upwards and a bit to the left.
Completed all cycles of Xiaflex as of April 2019. Slight improvement from Xiaflex and now had a Penile Prothesis implanted Sept 9th 2019.

TonySa

I'd consult w stabler since she offered.  I called my insurance company directly and kept bugging them till it was pushed through.
PxD 2 yrs 9/16.  Failed all treatment. 9/11/18: excision, grafting & implant Dr Karpman MtnView Ca, AMS CX 18cm + 3-1cm RTEs.
Pump failed.  2/11/20 Dr Karpman installed Titan 22cm +1cm RTE.