End-of-Year Task: Renewing Your DMT Prescription for 2016

December is upon us, and besides being the holiday season, ‘tis also the season to renew our prescriptions for disease-modifying therapies and reapply for co-pay assistance.

I take Tecfidera, so during the month of December, I will contact Biogen’s patient support arm, MSActiveSource, to submit a new application for 2016 co-pay assistance along with my 2015 tax documents. Next I will contact my specialty pharmacy, OptumRx, and have them fax a prior authorization form and request for prescription renewal to my neurologist. This seems pretty straightforward, and it ought to be. However . . .

There might be some extra considerations. Since I am on Medicare, that disqualifies me for the pharma company’s patient assistance program. Fortunately, Biogen works closely with charity organizations such as Chronic Disease Fund and Patient Assistance Network, which will cover patients like me that have government insurance. Funds are limited and might not extend over the entire benefit year. I have to cross my fingers and hope for the best. So far I’ve had the entire year covered.

After I get the ball rolling on all of the above, the real work begins. The co-pay assistance people, the specialty pharmacy, and the neurologist won’t necessarily coordinate the details with each other. In fact, I won’t count on that happening at all. Then the phone calls begin. I will make several calls to the specialty pharmacy (OptumRX) to get an update on whether they have faxed the prior authorization and refill request to my neurologist and gotten a response. In past years they have repeatedly denied having received the information from my neurologist. It is my responsibility to call my neurologist to find out if in fact they did. Then the war begins. My neuro claims the info was faxed and the specialty pharmacy insists they never received it. Another call to my neuro reveals they received a confirmation that in fact the pharmacy did receive it. And on and on. Sometime in January, it all falls into place: The charity fund sends me an acceptance letter that my co-pay will be covered in full, the specialty pharmacy has received my neuro’s info, and now I can set up a ship date for my first delivery of Tecfidera. If I’m lucky, I have a supply of Tecfidera to get me through January while all of this is being processed. If I’m doomed to run out, the specialty pharmacy will arrange to ship me a small emergency supply.

This makes for a stressful few weeks every year, but the process is a necessary one, so I bite the bullet and muddle through. I hope your experience goes more smoothly, but if it doesn’t, or you are new to this, I hope my advice and experience will help you manage the ordeal.

Here’s a list of patient support numbers for the various pharma companies that manufacture your disease-modifying therapies. If you need help with your co-pay, I urge you to contact them.

*Pharma co-pay programs are for commercially-insured patients only. If you have Medicare or Medicaid, call the same numbers to apply to charity organizations that will fund government-insured patients. Either way, they’ll get you covered.

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