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Insurance Won’t Cover Revlimid - HELP

lmbreen91
lmbreen91 CSN Member Posts: 1
edited June 2023 in Multiple Myeloma #1

Hi, 

My aunt has been taking Revlimid for 4 years now. It has been covered this entire time, but this past month the insurance company stopped covering it. The doctor has completed and appeal. My aunt has appealed. The doctor completed a peer to peer. The insurance company just will not cover it. They also will not tell her what comparable drug is covered under the plan. The drug is $14,900 without insurance, so it's not like she can pay that out of pocket. She currently is insured through Maryland Medicaid and Maryland Physician Care.  

I have emailed the health commissioner, no response. We have contacted the manufacturer of the drug via phone and a financial assistance form, no response. 

Does anybody have any experience with dealing with the insurance company / how to get this covered? It's obviously medically necessary. I just need some information / pointing in a direction. I feel like everything we have done has been met with a dead end. 

Thank you. 

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Comments

  • br_bernardo
    br_bernardo CSN Member Posts: 23 Member
    edited June 2021 #2
    Sorry I don't have any

    Sorry I don't have any specific advice (other than maybe try a lawyer??) but I do pray for your aunt :( I know it's not easy when they stop covering an expensive medication.

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  • jest5471
    jest5471 CSN Member Posts: 3 Member
    #3
    https://csn.cancer.org/discussion/comment/1685280#Comment_1685280
    https://csn.cancer.org/discussion/323075/insurance-won-t-cover-revlimid-help

    Try contacting the Leukemia & Lymphoma Society, I am taking Revlimid and they will help with paying the cost and other bills associated with cancer. ( lls.org )

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  • Kindra
    Kindra CSN Member Posts: 4 Member
    #4

    Have you talked to Social Worker at the hospital you go to they some times have grants to cover chemo’s that aren’t covered by insurance.

    I am in Fl on Medicaid and Medicare and a supplement and they cover Revimid.

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  • Harry_M
    Harry_M CSN Member Posts: 1 *
    #5

    Imbreen91 do you still need help with your aunt. I may be able to help

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  • jest5471
    jest5471 CSN Member Posts: 3 Member
    #6
    https://csn.cancer.org/discussion/323075/insurance-won-t-cover-revlimid-help

    I take Revlimid and my medication is taken care of by the Leukemia & Lymphoma Society go to their website and apply for help and they pay for the medication every month, also they offer help with other cancer related issues, this is the best thing I ever did since I started treatment.

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  • DLowe
    DLowe CSN Member Posts: 1 *
    #7

    lls.org

    paf.org

    Hi I am new here but there are several foundations that cover all the medications for cancer

    patient advocate foundation

    LLS.org

    and several others look those up and I hope they help God bless your family

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  • cs60
    cs60 CSN Member Posts: 2 Member
    #8

    The drug companies can help cover some of those costs- Call the specialty pharmacy that you use, they can help get that set up for you hopefully.

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  • Dawner7417
    Dawner7417 CSN Member Posts: 1 *
    #9
    https://csn.cancer.org/discussion/323075/insurance-won-t-cover-revlimid-help

    When I first started on Revlamid I didn’t have insurance. My doctor filled out for me to revive it free from Bristol Myer Squib. Now that I have insurance I and my doctor have filled out for co-pay assistance program. Just get with the doctor and contact Bristol Myer Squib. I hope they can help.

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  • jest5471
    jest5471 CSN Member Posts: 3 Member
    #10

    You can also contact lls.org and inform them of your circumstances and they will send you a prescription card to help pay for the Revlimid. Also try and request a prescription from your doctor for Lenalidomide this is the generic version for Renlimid, one other thing to try is to contact Onco 360, this is a oncology pharmacy who may be able to assist you with other payment options. Good luck.

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  • MJKkpk
    MJKkpk CSN Member Posts: 2 *
    #11

    Our insurance didn't cover it and it was 17,000 a month. We were lucky to get into a grant for the medication. See if your Dr can find one for you.

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