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sts66

08/12/16 3:10 PM

#88616 RE: Biobillionair #88565

CMS isn't helping either, they require prior authorizations for all Omega products including Vascepa, but not for fibrates

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Not true in my experience, need no pre-auth for V scrips.


CMS also requires post treatment Trig numbers for Omega's, if your numbers drop below treatment goals does CMS stop paying for treatment?



Not sure where you got that info, but the very idea that if your TGs get below on-label use of V an insurer would stop paying for it is just dumb. Imagine if you were prescribed BP meds, and because you are on them your BP is now under control - so insurance says "ok, you're better now, no more meds for you", although the underlying cause of elevated BP isn't resolved? You were just controlling the symptoms (changing a biomarker level in V case), not the cause. I will be on V the rest of my life as long as insurance continues to pay for it, and so will millions of other people, especially after R-IT results come out.
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SBsandman

08/12/16 4:49 PM

#88638 RE: Biobillionair #88565

BB-
I don't know that answer for sure, but I assume they would continue paying just like for a hypertension Medication after a patient's BP normalizes.