Re: Re: Anthem Blue Cross

[Guest guest]

WOW! I didn't know this. This is something I will bring up as I progress in my

case against BCBS. Boy, the more I think about this the more this could turn

into a class action lawsuit. I know I'm not the only one out there with this

problem and perhaps it should be mandated this med be covered on the pharmacy

side of ALL plans?

My BCBS covers it on the Medical side, not the prescription side. Humana was on

the medical and Aetna was on the pharmacy side. It will cost me more if I do

get approved thru BCBS but at least I won't have to pay the $14,000 per year.

Another interesting thing....a representative from Caremark told me Xolair is

the 2nd most expensive therapy-type drug on the market. It was second to a

hemophylia medication. No wonder they don't want to pay for it.

billybaroo1958 <cajjz109@...> wrote:

What I go through every month with Anthem is the

qualification, " your co-pay amount may change, but we will notify

you " . As it is now, I am still qualified as " self-injectable "

despite my doctor's protestations. But, there is always a

possibility that Anthem will eventually stop the pharmacy expense

for Xolair. I know that Blue Cross considered Xolair a medical

expense only, but Anthem over-ruled them when I first started. Thus,

I can still get it as a pharmacy expense. Eventually, I would hope

that a ruling body will jump in, with enough people complaining,

that the drug is prohibitively expensive under the medical expense

part of drug insurance.

The " black box " warning by the FDA didn't preclude self-injection,

just counseled against it. So, if any insurance company uses the

warning as a justification to force injections in a doctor's office

and thereby make it a medical expense, then that insurance company

would seem to be using this as a way to recover more money from the

patient.

>

> I do not want to precipitate a self fulfilling prophecy, but...

>

> I just received a letter stating that Blue Cross of California

will now be Anthem Blue Cross. It

> also states, " rest assured " we will continue with your excellent

services, you do not have to

> do anything.

>

> I am an advocate of " 's Law " , LOL, and was wondering if

anybody has had dealings

> with these people, if I should just stop worrying, or if I need to

prepare for a fight for my 3

> year ongoing prescription to Xolair.

>

> Ron

>

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[Guest guest]

Doug,

I was shocked to find BCBS denied my claim with reckless abandone. The

improvement with the management of my asthma because of Xolair has been nothing

short of miraculous and it is medically documented. Xolair is the medication I

hoped and prayed for, long before I even knew it was in development. The good

news for now....I am paying for the medication myself so I'm not going

completely off it but I won't be able to maintain the payment for long.

I'm really tempted to go off the Xolair and just go to the ER when I get sick

but I don't want to take the chance that it could be a lot worse than I expect.

It's just too big a chance but it's something I may eventually have to do.

uca79iii <bme1979@...> wrote: , I can't

believe that they are treating you this way. No one else

on this board is being abused like this. It is a shame you have to

resort to getting a lawyer just to breathe. My BCBS coverage is

COMPLETELY the opposite of yours.

See next post.......

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