I have just been diagnosed with multiple myeloma and am getting ready to start treatments.
My insurance turned down the authorization request for Velcade combined with Revlimid for my treatments, stating "the combined use of Velcade with Revlimid for the treatment of multiple myeloma is not considered medically necessary."
I'm wondering if anyone else has had this happen to them and what other treatment options would you recommend.
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Re: Insurance denying VRD / RVD treatment
There are certainly other drugs that can be used.
But you should really try to understand the details behind why your insurance company rejected the authorization (they very likely have a written clinical policy bulletin on the subject). It may be as simple as they want you to use Vd or Rd before using VRd. But if your doc has some pretty sound reasons for wanting to start you on the VRd cocktail, he can also appeal the decision.... but you first need to understand why they rejected if given their specific, written policies.
If I were in your shoes, I would simply call the insurance company and request the details and bulletins around your denial. And then I would contact your doctor's office for help in this matter.
But you should really try to understand the details behind why your insurance company rejected the authorization (they very likely have a written clinical policy bulletin on the subject). It may be as simple as they want you to use Vd or Rd before using VRd. But if your doc has some pretty sound reasons for wanting to start you on the VRd cocktail, he can also appeal the decision.... but you first need to understand why they rejected if given their specific, written policies.
If I were in your shoes, I would simply call the insurance company and request the details and bulletins around your denial. And then I would contact your doctor's office for help in this matter.
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Multibilly - Name: Multibilly
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: Smoldering, Nov, 2012
Re: Insurance denying VRD / RVD treatment
Hi Cindy,
Multibilly's suggestions are good ones. Find out the details of your insurance company's policies regarding the treatment of newly diagnosed patients. The insurance company probably has a written policy specifically for newly diagnosed multiple myeloma, and they should be able to either email it to you or point you to where you can download it online.
Once you have it, discuss it with your doctor and the reimbursement specialists at your doctor's office.
If your doctor has specific reasons for wanting to treat you with VRD / RVD, versus, for example, Rd, Vd, or VCD (CyBorD, Velcade-cyclophosphamide [Cytoxan]-dexamethasone), he or she in most cases will be able to convince the insurance company to approve your treatment with VRD / RVD.
The key, however, will be to get your doctor / doctor's office involved and have them go to bat for you and the treatment they want you to receive. In the case of many -- perhaps even most -- insurance companies, this will be enough to get you approved for the treatment your doctor wants you to receive.
Please keep us updated on what you find out, as your experience will be useful for other members of the forum to know about. You can just post updates here so that the information is all in one place.
Good luck!
Multibilly's suggestions are good ones. Find out the details of your insurance company's policies regarding the treatment of newly diagnosed patients. The insurance company probably has a written policy specifically for newly diagnosed multiple myeloma, and they should be able to either email it to you or point you to where you can download it online.
Once you have it, discuss it with your doctor and the reimbursement specialists at your doctor's office.
If your doctor has specific reasons for wanting to treat you with VRD / RVD, versus, for example, Rd, Vd, or VCD (CyBorD, Velcade-cyclophosphamide [Cytoxan]-dexamethasone), he or she in most cases will be able to convince the insurance company to approve your treatment with VRD / RVD.
The key, however, will be to get your doctor / doctor's office involved and have them go to bat for you and the treatment they want you to receive. In the case of many -- perhaps even most -- insurance companies, this will be enough to get you approved for the treatment your doctor wants you to receive.
Please keep us updated on what you find out, as your experience will be useful for other members of the forum to know about. You can just post updates here so that the information is all in one place.
Good luck!
Re: Insurance denying VRD / RVD treatment
Hi Cindy,
So sorry you are having to deal with this! Especially since I'm sure you are still wrestling with your diagnosis.
I agree with Multibilly -- you need to understand why they have denied your request. My guess is that it's because Revlimid has not yet been approved as a first line therapy for multiple myeloma, so they are considering it "experimental", even though many doctors do prescribe it up front. Getting the benefits people at your doctors office involved is definitely the way to go! They may need to send the insurance company additional documentation on the use of Revlimid as an upfront therapy.
EJ has not yet been on Revlimid, so we have not had to deal with this. I had a similar situation when I wanted to get approval to use a drug off label to treat my migraines. The insurance company considered it "experimental" and would not approve it. I think the bottom line was the cost -- it was expensive. In the end, we did prevail, but it took some time.
Good luck.
Lyn
So sorry you are having to deal with this! Especially since I'm sure you are still wrestling with your diagnosis.
I agree with Multibilly -- you need to understand why they have denied your request. My guess is that it's because Revlimid has not yet been approved as a first line therapy for multiple myeloma, so they are considering it "experimental", even though many doctors do prescribe it up front. Getting the benefits people at your doctors office involved is definitely the way to go! They may need to send the insurance company additional documentation on the use of Revlimid as an upfront therapy.
EJ has not yet been on Revlimid, so we have not had to deal with this. I had a similar situation when I wanted to get approval to use a drug off label to treat my migraines. The insurance company considered it "experimental" and would not approve it. I think the bottom line was the cost -- it was expensive. In the end, we did prevail, but it took some time.
Good luck.
Lyn
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Christa's Mom - Name: Christa's Mom
- Who do you know with myeloma?: Husband
- When were you/they diagnosed?: September, 2010
- Age at diagnosis: 53
Re: Insurance denying VRD / RVD treatment
I am sorry to here this. You really need to find out why and get your doctor involved. I am on Velcade, Revlimid and dex from the start. Where I was 6 months ago and where I am today is short of merciless.
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