Videx no longer covered by Blue Cross of CA

[Mirar]

I was just informed by my pharmacy that Blue Cross of CA no longer covers Videx and if I wanted to continue taking the drug it would now cost me $383 a month. Does anyone have any suggestions on how to get Blue Cross to cover it or get the drug at a lower cost?

[Blixer]

Videx is available in a generic version.  It was one of the earlier developed drugs although it has gone through some reformulation.  Will they cover the generic version?  Most insurnace companies have an appeals procedure.  That sometimes takes a while though.  Did they give you any reason why they were not covering it?  Have you called the company itself or just gotten the news from the pharmacist?  Have you talked with your doctor about it?  I know, you aren't supposed to answer a question with a question but I think it is prudent to do some digging to know where and how to start.  Good luck!

[Mirar]

Hi thank you for some insight. I first got the news from PrecisionRX that the drug was no longer covered, then I called my insurance company and they said that it is off their formulary and to get a possible exception my doctor would have to fill out a form requesting the Videx on my behalf and they would respond in 72 hours and as of Friday afternoon they said it was still NO.

I also contacted the drug manufacture and they said the following;

Thank you for contacting us regarding assistance in obtaining Bristol-Myers Squibb prescription medication. Since you have been turned down for Together RX Access, you may want to try, The Partnership for Prescription Assistance.

The Partnership for Prescription Assistance brings together America's pharmaceutical companies, doctors, other health care providers, patient advocacy organizations and community groups to help qualifying patients who lack prescription coverage get the medicines they need through the public or private program that's right for them. Many will get them free or nearly free. Its mission is to increase awareness of patient assistance programs and boost enrollment of those who are eligible.
Through this site, the Partnership for Prescription Assistance offers a single point of access to more than 475 public and private patient assistance programs, including more than 150 programs offered by pharmaceutical companies. To access the Partnership for Prescription Assistance by phone, you can call toll-free, 1-888-4PPA-NOW (1-888-477-2669).

Thank you for contacting Bristol-Myers Squibb.  If we may be of further assistance, please call our Customer Relations Department at 1-800-332-2056.

I also asked my insurance company for a list of drugs they cover and do not cover and was told that the list is updated quarterly and she had nothing up to date and she also told me that the only way to find out if a drug is covered is to have the pharmacy try to bill it. I would think there should be a better system in place instead of their hit and miss approach. I do not know if they will cover the generic version, cost wise there is not a huge difference between the two, I found it to be about an $87 difference per month. I don't have a lot of time to wait for an appeal because I run out of Videx in 10 days.

I see my doctor on Monday to talk about what I can take in place of Videx and it may mean having to start all over with new drugs I don’t want to speculate at this time. I know I hate to change something that works well for me.

[Blixer]

It might also be worth contacting the Insurance Commission in your state.  It is very scary that an insurance company can just "drop" a medication that you are taking, and particularly one that is very necessary.  I wonder what the overall deal is.  I have BCBS of Missouri (well now it is called Anthem) so I wonder if it has been dropped from all of their formularies?  I'm in a study so mine doesn't go through the insurance yet.

I just checked the Precision RX site under my benefits and sure enough, the Videx EC 200 mg, 250 mg, and 400 mg capsules are no longer on the formulary.  The 125 mg Videx EC capsule shows as still being on the formulary.  The generic version GENERIC NAME:   DIDANOSINE (dye-DAN-oh-seen) does show up on the formulary.  So if permitted by your doctor, you may be able to just switch to the generic version.  It is available in generic in 200 mg, 250 mg, and 400 mg.  I would imagine that it is most likely the same for the BCBS you are under.

[Mirar]

Hey Blixer, I appreciate it very much for talking to me and helping me find a solution. I met with my Dr. today and he was not very happy with the insurance company and said that I was the first to contact him regarding the Videx and he is counting on lots of phone calls from patients in the near future.

We both decided to drop the Reyataz, Epivir & Videx and go with Truvada, Lexiva, and Norvir and do lab work a month after taking the new pills. That is the best we can do for now and the good thing is that I can always go back if all else fails.

Thanks again for being so nice and helpful.

[Buckmark]

I also asked my insurance company for a list of drugs they cover and do not cover and was told that the list is updated quarterly and she had nothing up to date and she also told me that the only way to find out if a drug is covered is to have the pharmacy try to bill it.

This is bullshit.  In most states, insurance companies are *required* to provide you
with their prescription drug formularies -- usually in writing, if you ask.  And they
are usually required to notify you if they stop covering a medication, and also
suggest alternatives.

Call them back and demand the latest formulary.   If they can't or won't provide it,
report them to your state agency that regulates the insurance industry.  WTF are you
and your doctor supposed to do when trying to decide on medications -- read the mind of
your insurance company?

I see that you and your doctor have already discussed alternatives, which is good,
but that's a heck of a way to be forced to make treatment decisions.

Regards,

Henry

[Mirar]

I can’t agree with you more Henry, I did not have any notice from my insurance company the only notice I got was when I called the pharmacy to order the Videx and was told by the pharmacy that it was no longer covered by Blue Cross.

I did call Blue Cross and they would not give me an explanation but only to say that it was no longer on their formulary. After my conversation with them, a few days later they sent me an approved formulary drug list but the funny part is that in the list the column for HIV Agents there was a note “All oral and self injectable FDA-approved HIV agents are eligible for coverage under the prescription drug benefit. May be subject to PAB.” I have to add that the formulary that they sent me has already been changed and Blue Cross was not able to provide me with what is covered she told me that the new formulary was not available at this time. I asked her for something so when I met with my doctor we could have something to go on and her response was to submit the new drugs to my pharmacy and they would then be able to tell me if they were on the new formulary. It is total BS but they have us over a barrel.

I am in no position to fight them for several reasons, one is my short supply of Videx, the other is I don’t want to be on their hit list and be cancelled for no reason. I was left with no choice but to see my doctor right away to throw darts to come up with a new drug cocktail and that was just approved by them today.

I wish that the insurance company gave me notice about the changes so I could have planned in a more timely matter on a new game plan.

Thank you for taking the time to talk t me.

Bill