Kickas.org Forums Ankylosing Spondylitis General Discussion #1 AS Web Support Group Exception for a medication?

Has anyone had to ask Blue Cross/Blue Shield of Alabama for a medication exception?

I can not find any direction on their website and I need to know how to ask for an exception.

My company's RX plan requires us to pay for our meds up front and then be reimbursed at a percentage. Enbrel is at a 40% cost to me. That means that I have to pay all of $1359 and I am reimbursed for 60% of that $1359. This is not an option for me.

I have been granted an assignment of benefits that basically lets me pay the "co-pay" difference between the retail cost and my reimbursement quotient. That is still over $500 a month. I would like to see if, because Enbrel is the ONLY drug that works for MY AS, if BCBS will make an exception and let me have Enbrel at the 20% copay.

Has anyone had experience in getting an exception like this? I would be VERY grateful if someone knew how to do such an exception or even if it is possible.

Thanks in advance!
Holly

if my ins. wouldnt cover my meds i told my doc who sent in a pre-authorization to the ins. so my meds would be covered...maybe your doc can help you get what you need...and you might want to try the makers of the med sometimes they will help you get the med affordable to you ive heard that sometimes they provide the med themselves at no cost to you....either way it cant hurt to try....oak

Hi Holly,

I of course no nothing, but I really hope this will work out for you somehow.

Hugs,

Lisa

Holly, just wanted to wish you luck with this. I don't have any actual advice to offer, unfortunately.

Many hugs,