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Bummed Out - No Ritoxan

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#1 Peggy


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Posted 25 January 2008 - 01:54 PM

Got the call this afternoon that the insurance company isn't going to allow the use of Rituxan. How bad is that when an insurance company rules how you should be cared for and goes against what the doctor wants. Now that cyclophosphamide didn't work and can't use Rituxan I don't know what she will prescribe or do now. Just bummed out and depressed about the whole deal and sick of being sick. Thanks for listening.

Warm hugs from Minnesota.


#2 emmie


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Posted 25 January 2008 - 05:29 PM

Hi Peggy,

I'm so sorry about the ins. co. refusing to pay for the Rituxan. I feel the same way: why are the insurance companies allowed to dictate our treatments. We pay for the insurance; why isn't it there for us at all times.

I am trying to convince our insurance to pay for IVIg infusions for another 'disease' I have. In other words we are trying to get preapproval. So far, my dr. has written a letter, gathered info and studies showing that the infusions are successful for this condition and followed up on it with the same info and a new letter. No luck.

We are in the process of finding what form we can use to try and mount an attack. It all takes so much time and energy. Energy is so hard to come by and this can suck it all out of you.

Ah well...we will keep at it and hopefully give them enough solid information. Maybe they'll get tired of us and relent! We can hope, right?


#3 Sweet


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Posted 26 January 2008 - 05:48 AM

Unfortunately insurance companies are in the "money" business, not the "patient" business. How messed up is that?

Peggy, I'm really sorry. Have you doctor appeal it.
Warm and gentle hugs,

ISN Support Specialist
International Scleroderma Network (ISN)

#4 janey


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Posted 27 January 2008 - 06:32 AM



Sometimes insurance companies have a "tiered system" where you have to try one similar drug before trying another. Since Rituxan is a biologic agent, they may require another biologic agent first.


I would definitely continue to pursue this and see if this is the case. For me, this tiered system has come into play 3 times with my medications.

Janey Willis
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International Scleroderma Network (ISN)