Rituximab

[Brooke]

So Rituximab is FDA approved, just not for Wegener's Disease, correct?

[JanW]

absolutely. You can look it up. It has been used to treat cancer for some time.

[Brooke]

Ok thanks, just wanted to make sure I was understanding correctly.

[Sangye]

When the FDA approves a drug, it approves it for a particular disease or condition. However, docs are able to prescribe the drug to treat other conditions. That kind of use is called "off-label" prescribing. Perfectly legal and very common.

Ctx is FDA-approved to treat certain types of cancer. It's used off-label to treat Wegs. Rtx is FDA-approved for 2 types of cancer and Rheumatoid arthritis. It's used off-label to treat Wegs and several other diseases.

If it weren't for off-label usage, Weggies would have no drugs at all. Every drug we take is used off-label.

Drugs that are not FDA-approved yet are considered experimental.

[elephant]

Sangye, thanks again for the information on insurance and medicines. This is all very important, because one of us is probably going to go through the same thing that Brooke and Sangye have gone through with insurance/other stuff. This is great that we are so active on this site and respond to each other and give great info! Love you guys!

[Sangye]

You're welcome. If insurance is going to challenge rtx, this is the most likely way they'll do it. I'm glad I can share what I learned and hopefully save others time and stress.

[Brooke]

I'm still waiting to hear from ins company. We sent over another letter, apparently they didn't even get the first letter from the Mayo Clinic Doctor. I will let you know as soon as I hear something.
Sangye - how long did the whole process take for you?

[Sangye]

Aaaaargh... isn't it amazing that so many insurance company faxes work just fine when signing up new customers, but just can't handle those prior authorization letters?

The Cellcept debacle went on 3 weeks before I realized what the issue was. When I told them there is no "Wegs drug" they authorized it on the spot.

They have an "Expedited Prior Authorization" process for things like this. It's usually 24-48 hrs to get an answer. Assuming that the fax machine *cough cough* works. Double check that they're doing it that way.

[Col 23]

Love to know how you got on Brooke.
Col 23

[Brooke]

Hi~
Of course I am still waiting. I spoke with a lady yesterday, she said she needed me to type a quick note saying that I am appealing their decision. So, I did that and faxed it over directly to her. I called her this morning to see if she received my fax, she said yes and I guess we didn't need that letter so we are starting the appeal process! Grrrr - she said she put a rush on it (however you do that) and she will call me as soon as she hears something. I asked her if it would be today, and she said she is hoping it will be today.
Yesterday she said - if anything, like I need the medication right now, maybe I can buy it and appeal afterwards.