My Xiaflex experience

[RB3]

I did the first 2 shots at the Univ. of Utah with Dr Brandt.   I have kept up on the modeling and stretching,  and it seems like there is some noticeable improvement in the curve, and a noticable improvement in the quality of erection.  All very encouraging.  I am scheduled to do the next round in two weeks from now but I have just received the bad news from Premera Blue Cross that they have denied to pay for even the first injections let alone the second and beyond.  They claim that my policy doesnt cover Experimental procedures.  Even though the drug is FDA approved.

So now I doubt that I will be able to continue in the trial due to the ridiculously high price of the drug.  I cant believe that the Drug company doesnt want to keep as many of us in the trial as possible so that they can move this promising treatment forward to the main stream where the real profit is.  Especially someone who like me is having very promising results after the first  round.

[james1947]

RB3

I split your topic that your reports will be concentrated and other members will benefit fro your reports.
Regarding insurance, you should fight with them, as the drug is FDA approved.
I hope Hope4all will chime in as he understand better than me in the subject of insurance.
Until you will get some specific answers, search on the Xiaflex board, will give you the Xiaflex related insurance posts.

James  

[hope4all]

RB3. This is a common tactic insurance companies use. The most common tactic is to deny services by saying something is not medically necessary. They hope you'll give up after receiving the first denial. More often than not people do give up. Fight them, you are worth the fight! Fight for those who will need this treatment after you.

Did U.S. Biomedical get prior approval from BCBS before shipping the drug to the doctors office? Have you called US Biomedical or Auxilium yet? If you need specific contact information, including people's names at both companies, PM me.  

Call BCBS immediately and ask for a fast track review so your treatment timetable is not negatively affected by their erroneous denial of this FDA approved drug. Don't accept, "it will take 30 days to review or 60 days to review." You don't have that time. You are in the middle of your treatment, don't let them interrupt it. Talk to the head of the Care Management Department. Do whatever you need to. Take a day off of work and call everyone you can at BCBS. Do not relent. Call the State Insurance Commissioner. The people that are persistent and call and bitch the most get what they want.

Good luck to you my friend, and keep up the good fight!
hope4all


 

[hope4all]

I'm pretty sure Dr. Brandt's office has had many Xiaflex patients before you...I've seen his name on these boards often. He should be able to help with the approval of the drug and dealing with BCBS. I'm sure he's dealt with them A LOT and probably knows the name of the medical director there at BCBS.

The drug is out of the trial process and fully approved for Peyronies Disease by the FDA.  There shouldn't be a problem unless your plan specifically excludes sexual dysfunction.  If you are a federal employee and have one of the FEP Blue it exclude treatment for sexual dysfunction. They'll pay for a penile implant though...crazy logic. I know that certain FEHB plans deny treatment for Peyronies Disease, not sure if BCBS does.

[Tdurden]

Push back on the insurance company. Demand reconsideration, appeal it, get them on the phone etc. Aetna covered mine completely, but it was a bureacratic hassle at first. My doctor's assistant was supposed to get it all set up, but she took so long I gave up and got the BioMedics number from her and called them myself. They were actually very helpful. They called Aetna and got pre-approval and sent it to the doctor. I talked to Aetna myself to confirm the coverage beforehand because it is so expensive. Before each series BioMedics would call me and ask if I wanted to send it to the doctor, and I would say yes. It is weird to have to talk directly to the drug company, but do it. They helped me so they might help you. Hang in there - insurance companies will correct their denials if you keep after them.