Sign in to follow this  
Followers 0
fragiledancer2

Authorization for Rituxan?

4 posts in this topic

Hi- My rheumatologist is recommending IV Rituxan if my 3 gram Cellcept is not working - I relapsed after 12 years. I wonder if anyone has been successful in getting their insurance to pay for this - and what data you have given them, as I just got notified my insurance will not pay. Somebody at the office does the authorizations, but I wonder if my sending in recent academic research articles on successful Rituxan trials might be of benefit.

Share this post


Link to post
Share on other sites

Hi Fragiledancer,

 

I'm afraid I can't advise you as to whether your insurance company will pay for your IV Rituxan treatment, as I'm in the UK and I've no experience of private medical cover. (I've always been treated by our National Health Service).

 

However, I have found you a couple of threads "Rituxan Paid for by Drug Company!" and "Mini Allo HCST. Wife now has scleroderma. Suggestions?" whereby some of our members are discussing the payment of Rituxan by their insurance company.

 

I do hope this will be helpful to you and you are able to get the authorisation that you require.

 

Kind regards,


Jo Frowde

ISN Assistant Webmaster

SD World Webmaster

ISN Sclero Forums Manager

ISN News Manager

ISN Hotline Support Specialist

International Scleroderma Network (ISN)

Share this post


Link to post
Share on other sites
Hi- My rheumatologist is recommending IV Rituxan if my 3 gram Cellcept is not working - I relapsed after 12 years. I wonder if anyone has been successful in getting their insurance to pay for this - and what data you have given them, as I just got notified my insurance will not pay. Somebody at the office does the authorizations, but I wonder if my sending in recent academic research articles on successful Rituxan trials might be of benefit.

 

I think it really depends on how the insurance company classifies it. They seem to have leeway in the classification (or tiers) of drugs and treatments. Before Cellcept became available as a generic, I had my copays change based on the tier of drugs my insurer used to classify it. All of them have required prior authorization for Cellcept.

 

But if your insurer classifies it as "experimental," then you'll have a really difficult time. Is Rituxan an approved treatment for sclero? I know people who have taken it for RA and the insurance co. has paid for it.

Share this post


Link to post
Share on other sites

Hello Fragiledancer

 

I am so sorry that you have relapsed after 12 years, that must be very, very hard to deal with. As I am in the UK I can't help with your specific query, what I can tell you is that a dear friend had rituximab (rituxn) here in the UK and felt it helped her. Funnily enough she had to have the funding for it agreed by the local health authority, well I think it was the local health authority, I may have my orgs mixed up but I do know the cost had to be authorised.

 

Take care.


Amanda Thorpe

ISN Sclero Forums Senior Support Specialist

ISN Video Presentations Manager

ISN Blogger

(Retired) ISN Sclero Forums Assistant Manager

(Retired) ISN Email Support Specialist

International Scleroderma Network (ISN)

Share this post


Link to post
Share on other sites

Create an account or sign in to comment

You need to be a member in order to leave a comment

Create an account

Sign up for a new account in our community. It's easy!


Register a new account

Sign in

Already have an account? Sign in here.


Sign In Now
Sign in to follow this  
Followers 0