Radicava (oral) approval time

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affected

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I'm happy dancing for you, while muttering about how rude it was to put you both through all this stress.
Never underestimate the squeaky wheel!
 

lisa g

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I am so glad you received the medication. I'm on day 3 of taking it and the only complaint I have is getting up at 6:00 am to take it so it doesn't interact with my Riluzole and AMX0035. It's only for 10 days so I'll deal with it.

I just did all the paperwork with the Amylyx care team and my doctor wrote the prescription for Relyvrio (AMX0035). I was told that the process will take 4-6 weeks to receive the drug. I'm sure it will be longer since my insurance company doesn't have it listed yet for coverage. We'll have to wait and see.
 

ace_cals

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We've been having a similarly difficult time getting the oral radicava. First jumping through the hoops of getting the insurance to approve (Express Scripts), not understanding how JourneyMate is meant to help (they haven't really, except getting the $7500 co pay assistance), and now, trying to understand what the cost per month is going to be. We've been quoted $45, $11,000, with the latest estimate being $3900 per month. We've definitely hit our out-of-pocket maximum, but no one at Express Scripts seems to be able to confirm that we won't be on the hook for $3900. Maddening!
 

lisa g

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It's crazy with different insurance companies having different copays and as you said the hoops we have to jump through just to get approved for the drug. I hope you have a solution soon.
I can't wait to see the hoops we'll have to jump through for Relyvrio(AMX0035) the care team called me this morning and said all the proper paperwork was sent from my neurologist now it will go to insurance. I'd be surprised if that gets approved with little complications. We'll have to wait and see.
 

wmilo

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For Medicare patients, the IV version falls under Part B and the cost is included in the annual out of pocket maximum. The oral form falls under Part D and is not limited by the out of pocket maximum. Don't know how non-Medicare coverage works.

For me, the co-pay begins with the "normal" amount (33%), then becomes the "donut hole" coverage (25%) and then "catastrophic" coverage (5%). Because of the cost of the drug, this happens within one month, so the first fill is high, and subsequent fills are lower but the cost can be shockingly high. This is how it is working for me and YMMV.

I have spent hours on the phone with my insurance, Accredo, and Express Scripts. :(
 
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