Re: qgel covered under orphan drug status

[Guest guest]

I am way behind on emails.

You may want to inquire with your insurance plans if they cover orphan drugs.

You will probably have to be persistent and ask for the answer in writing if

they do or don't. Demand a copy of a manual or such. In 2001 in an appeal for

Q10 (not Qgel) I received from the top level of Tricare miliatry insurance a

letter stating that they do not pay for vitamin supplements even if necessary

but the person writing the letter also included excerpts from the manual which

said this and also that they do pay for drugs with orphan drug status.

I recently won an appeal to my federal insurance plan, Tricare military

insurance to pay for the Qgel under orphan drug status. In 2003 I had won an

appeal and they started paying for it at the rate of 75% (we have 25% copay).

Then they changed administrators of the plan in July 2004 and did not pay for

it. Went back and forth with appeals, they said needed NDC numbers, needed a

perscription, then sent back a prescription saying it was no longer made, etc.

This went on for over a year. In early March of this year went thru my

congressman.

Got a call in late April from a representative from the mail order pharmacy that

started processing claims in Jul 2004. Said they could not process the claim

because Epic and Tischcon did not have pharmacy number. They sent it back to

the congressman's office. The Congressman's office sent it to the civilian

administrator that processes everything except prescriptions. At the beginning

of June received a check for 75% for Qgel purchases from March 2004 until Nov

2005.

I am trying to find all my receipts from Nov 2005 until now to send in. When I

do I will again send in the literature from TRICARE that I received back in 2001

saying they pay for drugs that have orphan drug status as well as my letter from

the congressman.

Re: Can federal health plans be legally compelled to cover

(or consider covering) CoQ10 for Mito?

>

> > Any lawyers here? Wondering if there might be a way

> > to convince or compel health insurance plans -

> > particularly federal plans, like Medicare, Medicaid,

> > the Federal Employee plans, etc. - to cover some of

> > the cost of CoQ10 and maybe some other supplements

> > recommended for Mito.

>

>any interest in trying to compel one of the coq10 manufacturing

companies to offer their product at a reduced rate for individuals

with mitochondrial disease diagnosis? cannot hurt to ask, esp if one

could represent a significant # of individuals sufferring from the

disease......possibly thru the organization representing people with

mito diseses??? i think pharm companies have done so in the past....