RE: Re: Reauthorization by Athem-CA

[Guest guest]

Interesting as I use Wellpoint as well (had been Medco and in now

NextRx/WellPoint) and I have never seen a prior authorization. We have

Anthem BC of CA PPO (and moving to the EPO as of 1/1/09). I definitely have

the IgE level and aeroallergen (3 de-sensitizing shots a week for the last

10 years). Not sure what my FEV1 is now or has been but in general I think

my lungs are better than most here. Only issue I have is I go for 90% to 50%

real fast when exposed to an allergen (or at least did before Xolair.) I am

airborne anaphylactic to egg.

I wonder what my allergist has said on my forms..

B.

From: [mailto: ] On

Behalf Of billybaroo1958

Sent: Sunday, December 28, 2008 4:31 PM

Subject: [ ] Re: Reauthorization by Athem-CA

Actually it is a requirement, on the prior authorization form used by

Wellpoint Pharm: IgE

level of greater than 30, one positive test of an aeroallergen and a FEV1

below the 80th

percentile.

> > >

> > > I have Anthem BC of CA and have not had to fill out any

> paperwork . I have

> > > been getting Xolair for over 2 years now and have never had a

> review. It

> > > might be how your employer (or those who offer the plan) have it

> set.

> > >

> > >

> > >

> > > B.

> > >

> > >

> > >

> > > From:

<mailto: %40>

> [mailto:

<mailto: %40> ] On

> > > Behalf Of billybaroo1958

> > > Sent: Saturday, December 27, 2008 11:55 AM

> > >

<mailto: %40>

> > > Subject: [ ] Reauthorization by Athem-CA

> > >

> > >

> > >

> > > I don't imagine everyone fits the criteria of the question, but I

> am up for

> > > an annual review if

> > > whether I should be allowed to stay on Xolair. I have been on one

> year, and

> > > my assumption is

> > > that it is policy for Anthem CA to have the patient re-submit a

> new prior

> > > authorization every

> > > 6-12 months. I remember vaguely a conversation here about someone

> who

> > > improved

> > > clinically on Xolair and was taken off because his/hers numbers

> went outside

> > > the criteria

> > > range to stay on the drug. Stupid we can all agree, but despite

> my IgE

> > > (before Xolair 355 and

> > > after 525) still within the criteria, my positive tests for

> aeroallergens

> > > while on Xolair, my lung

> > > functions have improved enough (>80% for FEV1) to say that I

> don't require

> > > the drug. Of

> > > course the idiotic logic is that it was supposed to help my lung

> functions.

> > > However, my

> > > doctor has told me that Anthem might want to see me fail again in

> order to

> > > put me back on

> > > it. Clearly I know this is all about money, but I feel like a lab

> rat.

> > >

> > > Just for anyone's edification, if lung functions improve because

> of Xolair,

> > > that should be a

> > > logical outcome and not a reason for removal from the drug.

> However, if IgE

> > > numbers

> > > plummet AND positive tests for aeroallergens are negative while

> on Xolair,

> > > then that might

> > > justify a period of time off the drug. I will let you know what

> happens, but

> > > I have begun to

> > > prepare to have to fight to stay on the drug because I did so

> well on it.

> > > Crazy

> > >

> > >

> > >

> > >

> > >

> > >