Replies to post #166522 on Amarin Corp Plc (AMRN)

[bfost]

CMM - I agree with you

I do appeals for insurers. Every appeal denial must pass through the hands of a physician - not an algorithm or a robot. (initial denials are algorithms). And every peer to peer request must be allowed. Even if the denial is upheld due to a formulary issue it will make the Pharmacy and Therapeutics committee aware of the issue and they may possibly review the decision. Contrary to popular belief the people on these committees often want to do things in the best interest of the patient as they analyze the cost/benefit issues involved.
Paying an extra $50 month for a 25% MACE reduction is different than $1000/ month for a 15% reduction (ex. PCSK9's).

It's not quick or easy but getting better coverage needs a multi pronged approach with AMRN, providers and patients while we wait for the expanded label.

[jessellivermore]

cmm3rd.....

Hey..everybody has a right to his own opinion...IMO the insurance wont even glance at a blog from a bunch of lay people...They just don't care what you think...

That said if you feel passionate about it feel free to start your own website ...and good luck...

":>) JL

[sts66]

I doubt a mountain of complaints would mean anything to legal authorities - V is currently not approved for R-IT indication, insurers have no duty to cover it for off label use. Another thing - this "they'll save more money by reducing CVEs" - that's only true for integrated insurers like Kaiser, one stop shops for medical care and drug coverage - it does not apply to PBMs or individual drug plans - the cost of treating an MI does not fall on the drug plan insurer, so they don't have any incentive to cover V until AMRN gets R-IT indication on label, will just cut into profits since coverage rates for 2019 are already set in stone.