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Monday, August 22, 2016

BlueCross /Blue Shield (BCBS), in the State of Alabama now thinks it knows what is best for the MS Patient -


                                                                  


information updated - 08.22.16
  
MS Views and News has recently learned that BlueCross / Blue Shield (BCBS), in the State of Alabama now thinks it knows what is best for the MS Patient

See how to write to BCBS Alabama by reviewing the information showing below
BCBS Alabama is changing criteria that they think is better to insure for the ms patient

Previous to this new ruling, BCBS like most payers (insurers), followed the FDA protocol labeling for an MS Medication. Prior to BCBS changing their policy, Lemtrada could only be prescribed if an MS patient used at least Two other FDA mainstream medications and the requirement for Tysabri was that the patient had to use two other FDA approved mainstream MS therapies or Lemtrada.

Note: BCBS Alabama has this new ruling went into effect on August 1st, 2016 that requires that for a patient to be insured Lemtrada therapy (once a year infusion medication for Multiple Sclerosis) that they first must use THREE other mainstream medications and for those wanting to use Tysabri (a once per month infusion therapy for MS), they must now use TWO other mainstream medications and have not used Lemtrada previously. So, if Lemtrada does not work, you are not even allowed to use Tysabri... 

All the information pertaining to what is written above, in more elaborate detail is showing below.

Before looking at the long winded information shown below, there may be some of you wondering maybe, so what is the problem or why the big deal?

So here is my answer and please remember that I am writing this from my own opinion and that this opinion is merely based on what I have learned over the years and what I can imagine being most dreadful or dangerous in years to come for most MS patients on a therapy that is as effective as the ones mentioned.

Question: Why the heck is this insurance company messing with your health?
Why would they want you to worsen before slowing the course of the disease progression? What basis do they ( the insurers) have to not allow you to take TYSABRI® (natalizumab) Or LEMTRADA® (alemtuzumab) more quickly (for quality of life purposes), rather than waiting for another medication to first be used? 

Why are they not thinking rationally to know that it might cost them a heck of a lot more, if you are not doing well with your current ms treatment and instead then need to be hospitalized for one thing or another due to your MS.. How much higher would the cost then be? However, BCBS is probably thinking that this probably would not happen to many people and that their costs would still be far less than paying for the medication.

Who loses? The answer is pretty simply. We ( the MS patients) are those who lose. Not necessarily you or me. But yes, Us, being the MS patients. Patients who might need to be switched from a medication treatment therapy (or having been on two) that might not be working for them and instead of that person then having the option to be switched to a treatment plan of either Tysabri or Lemtrada, they may be denied due to the new BCBS Policy.

Sure you might not be living in Alabama and so you might feel safe?? 
Well let me give another thought of mine.. What if BCBS decides hey, why stop with Alabama? Let's do the same in other States OR worse, what if other Payers (Insurers) decide to follow the new BCBS policies. 

Then what? Where does it stop that these Payers (Insurers) are not thinking of YOUR Health and instead thinking of their own pockets? What is then to stop other insurers from doing the same thing and what if then they decide that you cannot switch your current treatment option because they come-up with new protocols for those medications as well?

Yes, we deserve to have options. Options that are available to and for our use as MS patients, that might enable for better Quality of Life? Options for medications that might allow you to continue to walk, think, work, be less fatigued and so much more....

Yes, YOU can make a difference. 
You as the Patient or You as a Healthcare Practitioner living In Alabama

Individual patients can reach out to the BCBS - Alabama customer service department: 
  By CLICKING HERE    -- Please click the link (to the left) to access the BlueCross/BlueShield (BCBS) comments page.

Or you can direct your email directly to the big person at BCBS Alabama 
Mr. Terry Kellogg Chief Executive Officer (CEO) Blue Cross and Blue Shield of Alabama/Tennessee - 450 Riverchase Parkway - East Birmingham, AL 35244     
     VIA EMAIL: tkellogg@bcbsal.org  

    Yes, click the above website link or send an email to the CEO and let them know how you feel

     ANOTHER way in which to connect with BCBS of Alabama is through their Facebook page - found here: https://www.facebook.com/BCBSAssociation 


I am hoping that ALL MS Patients in the State of Alabama will contact your Blue Cross/Blue Shield (BCBS) office to voice your opinion and I am hoping that ALL MS Healthcare Practitioners in Alabama do the same. 

Plus for all healthcare providers (clinicians) outside of Alabama, You too can submit a comment if you have patient who live in Alabama..... 



-Draft IV Multiple Sclerosis Medical Policy Prior Authorization Program Summary


 PLEASE COMMENT    //// 

  Also to please contact BlueCross/Blue Shield (BCBS) as showing above






7 comments:

Stuart said...

After writing the attached, I also learned that BCBS Alabama is seeking an average rate increase of almost 40% for their Obamacare plans...

What else could they do to make life difficult for MS Patients?

~ blessings and light ~ said...

For the purpose of qualifying, would Solumedrol qualify as the first failed medication? It seems like everyone gets at least one round of this at the time of diagnosis, but I've never heard anyone using it long-term.

Jim said...

Our company has corporate offices in Kansas and Texas but they switched our insurance to BCBS Alabama. So you do not have to live in Alabama to be affected by their policies.
They have a similar view when it comes to physical therapy. They will not pay for PT for MS because they consider it maintenance. They are correct that it is maintenance but without it the conditions deteriorate.

Vicky Poche said...

My husband has BCBS as a supplemental plan to medicare, I wonder if this will effect him, because he has already had his first round of Lemtrada in January 2016. Expecting to do his second In January of 2017.

Laura Kolaczkowski said...

Well this just stinks for many reasons, but first and foremost in my thinking is that BCBS is now playing doctor and making choices about our health care without a license to practice medicine. These decsions should be between the doctor and person needing treatment and not the insurers. they could handles these costs out of their profits... or their CEO salaries. But then again, that is all secret so maybe not.

http://www.pnhp.org/news/2015/september/want-to-see-what-alabama-insurance-executives-make-new-law-says-thats-now-secret

Concerning about this story -for every one !!

Laura Kolaczkowski said...

Well this just stinks for many reasons, but first and foremost in my thinking is that BCBS is now playing doctor and making choices about our health care without a license to practice medicine. These decsions should be between the doctor and person needing treatment and not the insurers. they could handles these costs out of their profits... or their CEO salaries. But then again, that is all secret so maybe not.

http://www.pnhp.org/news/2015/september/want-to-see-what-alabama-insurance-executives-make-new-law-says-thats-now-secret

Concerning about this story -for every one !!

mswarrior said...

I have BCBS Alabama and they have been wonderful in paying for all my MS drugs including NUVIGIL, which I understand is a rarity. Maybe I am grandfathered?