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sts66

12/06/14 3:13 PM

#39666 RE: ralphey #39656

Thnx for posting that Ralphey, and thanks to Kiwi for getting you here - got any advice for someone like me, who has insurance that is moving V from T2 in 2014 to T4 in 2015 in favor of generic L? They're not denying coverage for V, just pushing a $11/mo cheaper inferior drug onto patients. I've been struggling with how to write up an appeal letter, can't decide what approach to take.

jessellivermore

12/07/14 7:09 PM

#39703 RE: ralphey #39656

Hi Ralphey,

Are you an MD,a clinician?

I've read your letter, I'm afraid you are a little off base.

The problem (I and the drug reps notice) is not really with the insurance companies. Insurance companies (like Akanz's) can and do decide the tier level, or decide not to cover the drug. They can also deny it based on pre approval; but as a rule, they do not exchange one drug for another. An exchange might occur at the pharmacy aided by the prescribing doctor. And according to the drug reps it is a problem because, according to them, some drug stores companies are incentivised to prescribe generics or cheaper brands they feel are of equal benefit. The doctor at least in Fl. or Ma. can put an end to that practice, simply by mandating "no substitutions".

Pharmacies and insurance companies mainly operate based on FDA labeling (understandably), and are not going to be persuaded by any of your updates.

Most everybody on this board is familiar with your "facts", but the real problem for Vascepa is the clinicians do not know much about the drug and its wonderful benefits. Recently I attended an Amarin sponsored event in the Orlando Fl. The Amarin sponsored speaker was a self described "Lipidologist"..His talk was riddled with factual errors and misconceptions...and this guy was being paid by Amarin. How can we get the scripts up, when 95% of PCPs knows almost nothing about the real pathophysiology of EPA and its effects on CVD..

":>) JL