Saturday, June 28, 2014

Yvonne Decelis, Columnist,

Yvonne Decelis
Insurance refusing to cover my Tecfidera

Hi there. For those of you who do not know me, my name is Yvonne Decelis and I have relapsing remitting MS.

Back in July of 2013 I went off of Avonex, my MS disease modifying drug (DMD) that I had been on since 1998.  I chose to switch to Tecfidera and as soon as it was available in the US I told my Neurologist to put me on it. Unfortunately, due to my insurance (Medicare Part D plan - Humana which I plan to change soon) refusing to cover it, I was off my DMD for 5 weeks. This unintended “medication vacation” made me quite a bit worse off physically. My fatigue became much more pronounced and I needed more sleep than I had in over a decade. It took me a long time to get over the med "break" and I never really fully recuperated.

I finally got on Tecfidera and have been on it a little over six months now. The Tecfidera has been helping me a LOT (numbness easing off, feeling less "muddle headed", regaining muscle strength) but now my insurance company is giving me trouble and refusing to cover it without a “prior authorization letter” from my Neurologist - AGAIN! I would have thought a prescription from a doctor’s office would have been enough (well, that and the fact that I have an as of yet incurable lifelong illness)! Apparently I was mistaken. I would state that I think it is crazy that they need a "prior authorization letter" on an annual basis but it appears they need them more frequently as I have only been on Tecfidera for 6 months.

Where can we turn when things like this happen? Why don't these people who work in the "do no harm" medical profession understand what they are putting us through when they do this to us?