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View Diary: Health Insurance Denied My Wife Medication (27 comments)

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  •  Essentially the doctor is recommending a drug (3+ / 0-)
    Recommended by:
    glorificus, ladybug53, CuriousBoston

    for a purpose not approved by the FDA.

    You may want to contact the drug manufacturer to see if they are testing this drug for conditions such as hers and participate in a formal drug trial.

    The most important way to protect the environment is not to have more than one child.

    by nextstep on Sat Dec 10, 2011 at 05:50:17 PM PST

    •  I don't think this is an FDA issue (2+ / 0-)
      Recommended by:
      glorificus, ladybug53

      We were able to get her first dosage on her insurance.  Then we had to switch to mine.  My insurance is denying this because under my plan there are only certain conditions that are considered medically necessary for this drug and hers isn't listed.  Although, one condition listed may have a relation to my wife's issue

      •  Make sure, contact the med company! eom. (0+ / 0-)

        Social Security is an INSURANCE PROGRAM. FICA FEDERAL INSURANCE CONTRIBUTIONS ADMINISTRATION.

        by CuriousBoston on Sat Dec 10, 2011 at 09:04:45 PM PST

        [ Parent ]

      •  Follow jpmassers' advice down below. (0+ / 0-)

        Document everything every step of the way. Be squeaky to the point of a lion roaring. Would occupying the CEO's house be an option?

        Social Security is an INSURANCE PROGRAM. FICA FEDERAL INSURANCE CONTRIBUTIONS ADMINISTRATION.

        by CuriousBoston on Sat Dec 10, 2011 at 09:07:13 PM PST

        [ Parent ]

      •  The FDA is absolutely an issue (2+ / 0-)
        Recommended by:
        SmileySam, CuriousBoston

        FDA does not issue blanket approvals to use a drug for any and all reasons. The approval covers only the condition(s) the drug  was used to treat in the clinical trials submitted with the approval package. Because that's what the evidence (trial results) supports.

        Doctors sometimes prescribe "off-label" based on what research is available, especially if a person has a rare disease as your wife does. But without FDA approval for using drug X for disease Y, it may well be classified an experimental use by some, many or all insurance companies.

        Different companies have different rules (especially in the details), which is why you can get different results from your policy versus your wife's policy. Check out the appeal rights jpmasser listed. When a rare disease is involved, sometimes you can get an exception to the experimental use policy.

        But you also need to check ClinicalTrials.gov for drug name + disease name. Expanded access phase 3 clinical trials also will be listed there. Rules and procedures for other compassionate use and single-patient access are covered at the FDA web site

        Just because you're not a drummer doesn't mean that you don't have to keep time. -- T. Monk

        by susanala on Sun Dec 11, 2011 at 04:28:53 AM PST

        [ Parent ]

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