Anyone started on Radivica yet? Use this thread to discuss access/ insurance

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Well after 4 1/2 months we FINALLY got started on the Radicava! But, the day before my wife's 1st infusion was to occur, Option Care tried an end run to cancel the order on both the medical and insurance parts. It was nothing but a small miracle that one of the Option Care employees was able to make it happen. It was very disheartening and cruel to receive those phone calls within about 45 minutes of each other to torpedo the infusion process. It really smacked of conspiracy and a deliberate attempt to derail the process.

That being said, at least my wife is now receiving to drug. We are obviously curious to see how she reacts to the Radicava. Not to be sour grapes (especially to those still waiting) about the process, but it would have been much more reassuring to have had this drug 3 or 4 months ago. My wife, like many others were left hanging in the wind waiting for this drug as their conditions worsened during the past few months.

In my wife's case, she has deteriorated significantly in all areas and who knows if it would have been delayed a bit with an earlier delivery of this drug. Mostly, it was the mental anguish that she suffered thinking that it would be the next week, then the next week, then the week after that and so on and so on. A horrible way to conduct medial treatments or perhaps better said as "mis-treatments."

I hope that all that are waiting for this drug get it sooner than later. I just wish that those insurers, reviewers and other administrators really get an understanding of how precious each day is for an ALS patient. Good luck to all and keep up the good fight. I'll report back and let you know how my wife is tolerating the infusions.


I applied in December and received first round by home infusion on Jan 8th

Had port installed and am ready for round 2

No results yet!
 
My husband is going to get it through the VA.
 
I finished 2nd round and feel it has caused my progression to slow or stop.

I had to stop taking Baclofen since it was making me unable to get up from recliner to walker!
 
Romeosc - that is really great news for you. I hope your progression is indeed slowing down or even better stopped. My wife thinks that the Radicava is helping her as well. She is in the middle of her second cycle. I'm hoping it works as she is affected in several key areas. Good luck with your progress and keep us informed. Be well and stay strong. You can do it!
 
This is my husband's 3rd dose with no side effects. We had the VA cover the meds. I don't believe our our ins. Would have covered it. I was was told with everything use for the incisions o Radicava,it cost about 349,000 a year.
 
Question: is there anyone here who is not a veteran and who has Medicare + supplemental insurance who is receiving Radicava through home infusions?
Is your insurance covering the cost of the drug?

I have really been on the fence about getting on this drug, trying to determine if the hassle is worth the benefits. For me, “hassle” is a combination of out of pocket cost plus time involved with infusions.
I could probably get the drug infused though an infusion center (using Medicare Part B) with minimal to no copay. However, I’m assuming that if I switch to home infusions, then I would have to pay for the drug out of pocket as it is not covered by my part D plan. I don’t think I’d qualify for financial assistance.

Anyone else facing this dilemma?
 
anyone on radicava with an ALS score below 2?
 
Do you mean an ALSFRS <2? That would not make much sense. Or did you mean 20?

Karen, are your part B and D plans the same insurer? Also, are you sure reimbursement is not available under Part D? Frequently the published lists are behind P&T meetings, or reimbursement can be pending/on demand prior to P&T consideration, and is likely administered under the specialty pharmacy benefit, the latter sometimes contingent on disease management enrollment.
 
Thanks Laurie. I just got on Medicare. The part B and D are separate carriers. Part B would cover infusions in an infusion center. Part D is the rx plan, and I have that through Humana. If I were to have the infusions at home, administered by my spouse (who is a retired RN), it is my understanding that I would have to purchase the drug through Part D. My part D doesn’t cover the drug. It’s possible I’m misunderstanding how it works.

I was wondering if anyone else with Medicare + supplement is doing home infusions (administered by a friend or family member) and having any reimbursement issues.
 
A friend at a support group meeting said that Blue Cross cancelled their insurance after a month of being treated with it.
 
I have Medicare and BCBS and it is being covered for home infusions.
 
(1) Those of you with the option to purchase Medicare Advantage plans ("Part C") when you get Medicare, it is advisable to do so, since, for example, in the case of Radicava, infusion center expenses under part B, so to speak, can be played off against "Part D" since the MA payor is on the hook for both.

(2) Karen, what I was asking was, who or what told you that your part D carrier would not reimburse for home infusion drug supply of Radicava? Most PBMs are covering it in one fashion or another.
 
I got my Radicava thru searchlight , who hooked me up with Heritige Biometrics. My Medicare covers their part then I get the rest free because of hardship. I have nurses come to house and give infusions. Heritige sends meds and supplies to house. If it would of been expense I wouldn't be doing it. I'm on first week of the 10 day after initial 14 day beginning. Have had port put in on the 20th, no effects yet but I'm gonna give it a year and see, then desire if I will continue.
 
Thanks Laurie (and others). It sounds like I have to dig into it a little deeper if I choose to pursue getting on this drug.
 
KarenNWendyn I am on Medicare & have Farm Bureau supplemental ins.

They paid full price for Radicava and Healthwell.org grant paid for home infusion! Nurse came to set IV and teach us how. Now she comes to deliver 10 day supply and access port.

I have leveled off and believe Radicava has helped me continue walking with walker!
 
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