Insurance coverage

[del marrs]

My first post.

I'd be interested in knowing more about insurance voverage.

Does anyone know where I can go to receive more I formation about coverage.

[james1947]

del marrs

I split your post that members can answer to your question directly.
Until you will get some answers, proposing you to make a search on the forum main page regarding insurance, you will get all the related posts.
A search on the Xiaflex board, will give you the Xiaflex related insurance posts.

James  

[mark62]

I think this varies greatly from one insurance company to another and maybe even from one doctor's office to another based off how they bill.

In my case, it involved both my drug insurance and my health insurance (administered by two different companies).

The specialty pharmacy is paid directly by my prescription drug benefit - everything except the $40 co-pay.  The Auxilium Advantage program pays the remaining $40.  So my out-of-pocket for the drug is $0.

For the doctor, I pay my co-pay for a specialist which is $30 and the rest is covered by my health insurance as an in-office injection.

Based on what I've read on the board, I'm afraid my good fortune is unusual.  

[RB3]

I had the first two injections at the University of Utah hospital with dr. Brandt.  I have been religious about doing the modeling every day. and have seen some improvement.  My luck with the insurance is not so good.  My policy is with Premera Blue Cross and they have denied to pay for the injections claiming that the policy specifically does not cover experimental procedures.  bogus I think as they are the ones to decide which they consider experimental.
So I am now faced with the choice to pay out of my pocket the nearly $6000 per injection or not continue.

I find this process quite illogical,  if the Drug company wants to get Xiflex approved for wider consumption they need to get past these trials, so why are they gouging us for such rediculously high prices.  We dont even know if it will work.  It seems like they would want to keep as many people in the trial as possible, especially those of us that have had some improvement. But who can stay in the trial with those prices if the insurance doesnt cover it?

If Xiaflex wants me to stay in the program they will have do do a hell of a lot better than $6000 per shot!