Re: BC/BC of MA refusing to cover Xolair

January 24, 2008

>

> Hi all,

> I too am a relatively new member & veryyyyy frustrated.

> I received a letter from BC yesterday indicating that since my IgE is

> not between 30 & 700, I do not meet their criteria. My level is over

> 2000-- my doctor says we'll have to try to get my level down with

> pednisone. Has anyone else come across this-- especially in the

> Northeast?

>

Seeing all the posts in this group for the last 4 years, I have

concluded three things:

1. Not all medical policies are alike even if they are with the same

company

2. Not all benefits, co pays and premiums are the same

3. The insurance personnel who look over your your claims are trained

to look look at everything they can think of to keep from paying for

an expensive drug or procedure.

My advice is to ask your doctor to keep plugging at them and NEVER

give up. You are HIS patient and he should demand you get the

medication he chooses for you.

In the past few years lot of insurance companies have changed their

minds about xolair coverage. They have finally realized that they will

SAVE money in the long run because they will not have to pay for our

expensive ER visits or other expensive medications as much.

Good grief, my insurance has had to pay quite a bit on 3 cataract

surgeries 2 cervical disk fusion surgeries, diabetes medication,

testing strips and other side effect problems from Prednisisone. Yes,

Pred is cheap but in the long run my company has saved a bundle by

covering my xolair.

I used to have at least 4-6 er visits a year. In the 4 years I have

been on xolair, I have only had 2.

I was fortunate to have my BCBS of Penn know this and certify xolair

at once when my doctor first requested it in 2003.

Doug

Group founder

On xolair since 2003

January 25, 2008

I have BC/BS MA as well. My IgE level was in the

200's when I started on it. Luckily I have no had a

problem with my approval. Once my deductible is paid

my Xolair is covered at 100%. Accredo Nova Facto is

the specialty pharmacy my MA BC BS has me dealing

with. Is that who you have?!

I am wondering if the reason why they are denying you

is because the FDA has not approved Xolair for

patients with IgE levels higher than 700. There are

studies going on at the moment for the higher

approval. My Allergist is actually participating in

that study. I go on Monday to get my next Xolair

injection. If you want I can ask him what he thinks

you should do. In the mean time it might be a good

idea for you to contact Xolair's SPOC program and talk

to some one about your problem. www.xolair.com then

type SPOC in the sites search engine.

If you want, feel free to email me direct.

Kathe

--- harringj <gkjay51@...> wrote:

> Hi all,

> I too am a relatively new member & veryyyyy

> frustrated.

> I received a letter from BC yesterday indicating

> that since my IgE is

> not between 30 & 700, I do not meet their criteria.

> My level is over

> 2000-- my doctor says we'll have to try to get my

> level down with

> pednisone. Has anyone else come across this--

> especially in the

> Northeast?

>

________________________________________________________________________________\

____

Be a better friend, newshound, and

know-it-all with Mobile. Try it now.

http://mobile./;_ylt=Ahu06i62sR8HDtDypao8Wcj9tAcJ

January 25, 2008

Hi,

I have been on Xolair since May '05, and was approved, even

though my IgE was technically in the 'do not treat' range (1,300).

When my pulmo/allergist first spoke of Xolair, he already had other

patients on it, so he warned me that 'insurance companies will

fight', but the doctor got all the paperwork they needed (I have

Oxford in NY), and the insurance approved me right away. I realize

that standard procedure for insurance is to find any way to deny

especially with such an expensive medication, but I think my doctor

really 'fought' to get me approved quickly and easily, and I'm

covered at 100%.

From time to time I get a letter from Oxford about Xolair, but I

just let my doctor know about it and he takes care of it. So, having

a doctor who will go up against the insurance companies makes all the

difference. I hope that your insurance company reconsiders, my advice

is just to keep appealing their decision and to gather as much info

(lab reports, hospitalization records, breathing test results,

etc...), to show your insurance that you REALLY need Xolair.

Hope This Helps,

Meagan

>

> > Hi all,

> > I too am a relatively new member & veryyyyy

> > frustrated.

> > I received a letter from BC yesterday indicating

> > that since my IgE is

> > not between 30 & 700, I do not meet their criteria.

> > My level is over

> > 2000-- my doctor says we'll have to try to get my

> > level down with

> > pednisone. Has anyone else come across this--

> > especially in the

> > Northeast?

> >

>

______________________________________________________________________

______________

> Be a better friend, newshound, and

> know-it-all with Mobile. Try it now.

http://mobile./;_ylt=Ahu06i62sR8HDtDypao8Wcj9tAcJ

>

February 4, 2008

Hi, my IgE levels are between 4,000 and 6,000. Fortunately, I am a veteran, and

the VA health care system picks up my prescription costs - three shots every two

weeks. I live in Connecticut, and the VA is affiliated with Yale, so I see Dr.

Lobo at yale who manages my case with my pulmonary Dr. at the VA. Our high

levels are extremely rare - in the entire VA health care system, there are only

about 150 of us on Xolair. My doctor had me on 60 mg a day of prednisone for

four months before I started my injections to try and drop my IgE levels and - I

developed full blown Cushings disease - I finally tapered off last May. That

drug is just awful.

Anne

----- Original Message ----

From: harringj <gkjay51@...>

Sent: Thursday, January 24, 2008 3:27:56 PM

Subject: [ ] BC/BC of MA refusing to cover Xolair

Hi all,

I too am a relatively new member & veryyyyy frustrated.

I received a letter from BC yesterday indicating that since my IgE is

not between 30 & 700, I do not meet their criteria. My level is over

2000-- my doctor says we'll have to try to get my level down with

pednisone. Has anyone else come across this-- especially in the

Northeast?

________________________________________________________________________________\

____

Never miss a thing. Make your home page.

http://www./r/hs

February 11, 2008

could you elaborate a bit on cushings disease and how you tapered your

prednisone? i have been prednisone for a long time and have tapered from 20 to

12 over the past few months. any help is welcome.

thanks,

xo

leigh

Magnuson <magnuson.mary@...> wrote: Hi,

my IgE levels are between 4,000 and 6,000. Fortunately, I am a veteran, and the

VA health care system picks up my prescription costs - three shots every two

weeks. I live in Connecticut, and the VA is affiliated with Yale, so I see Dr.

Lobo at yale who manages my case with my pulmonary Dr. at the VA. Our high

levels are extremely rare - in the entire VA health care system, there are only

about 150 of us on Xolair. My doctor had me on 60 mg a day of prednisone for

four months before I started my injections to try and drop my IgE levels and - I

developed full blown Cushings disease - I finally tapered off last May. That

drug is just awful.

Anne

----- Original Message ----

From: harringj <gkjay51@...>

Sent: Thursday, January 24, 2008 3:27:56 PM

Subject: [ ] BC/BC of MA refusing to cover Xolair

Hi all,

I too am a relatively new member & veryyyyy frustrated.

I received a letter from BC yesterday indicating that since my IgE is

not between 30 & 700, I do not meet their criteria. My level is over

2000-- my doctor says we'll have to try to get my level down with

pednisone. Has anyone else come across this-- especially in the

Northeast?

__________________________________________________________

Never miss a thing. Make your home page.

http://www./r/hs

February 11, 2008

Cushings disease is usually caused by a tumor on the pituatary gland or on the

adrenal gland that causes your body to produce abnormally high levels of

cortisol - a steroid. Prednisone mimics the same symptoms - swollen face,

virtigo, weight gain, bruising (my arms would get so bruised it looked like

someone hit me) etc. Do a google search on Cushing's disease - oddly its a

common dog disease. The treatment is usually removal of the tumor on the

adrenal gland or lysodren pills. I tapered my prednisone down to 50 mg for 10

days, 40 for 10 days, etc. until I as down to nothing. I still use prednisone

in one of my inhalers.

ary Anne

----- Original Message ----

From: Leigh McCall-Alton <mccallalton@...>

Sent: Sunday, February 10, 2008 7:55:53 PM

Subject: Re: [ ] BC/BC of MA refusing to cover Xolair

could you elaborate a bit on cushings disease and how you tapered

your prednisone? i have been prednisone for a long time and have tapered from 20

to 12 over the past few months. any help is welcome.

thanks,

xo

leigh

Magnuson <magnuson.mary> wrote: