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Thread: Rituxan Question

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    Default Rituxan Question

    Due to complications of the bladder after 5 months of Cytoxan, my doc had me discontinue using it 2 weeks ago. He is currently trying to get me approved for Rituxan infusuins. Apparently insurance companies don't like to pay for it for some reason. We've upped my Pred to 15 mg daily in the meantime to try and protect me...
    My question is this? Has anyone here had the IV Rituxan? Was it used alone or in combination with another drug? I've read that it is usually used in combination with Methotrexate... altho my doc hasn't mentioned this yet. Possibly he is just waiting until he gets the Rituxan approval before we discuss it in depth. So far all of this has been done over the phone since my last appointment when he had me rushed to Urulogy due to the bladder bleeding.
    Getting nervous due to stopping chemo before remission, learning and starting a new med, having to up the pred after finally getting it down to 7.5, and just generally not feeling well. I have an appointment with my PCP on Monday at the Rhumy suggestion because I may be developing a respiratory infection, and also to recheck the urine for blood and run a CBC (Rhumy office is closed starting tomorrow, and will not reopen until January 10. (it's much cheaper co-pay wise for me to do all this at PCP rather than go to Pulmy for parts, and Labs for the rest, and my Rhumy *Bless him* is trying to 1)save me 2 different higher co-pays and 2)save me several trips to different places in differrnt cities.
    Thanks in advance for any thoughts or suggestions.
    ~Stacey~

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    I had the Rituxan Infusions in May of this year. It took a lot of calls back and forth with the ins. company to finally get it approved, they finally did. The methotrexate was not working for me, hence having to do Rituxan, I can't remember how long I was off of the methotrexate before the infusions. I was on 20 mg of prednisone and also on bactrim while receiving the Rituxan. The infusions went just fine for me.
    Good luck to you!

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    well, just got a call from the Rhumy office... the insurance company (Cigna) has denied me the Rituxan. Dr office is going to send me paperwork to sign that they will then send to the makers of the drug to try and get them to supply it for free. This could take several months... about to have a major come-apart here...

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    Don't fall apart!! Keep fighting!! Thats what I had to do! I also wrote a letter to the insurance company explaining that I am in my child bearing years and would like to have children in the future. Also noted the side effects of Cytoxin. I am surprised they would deny this since you are having problems with the Cytoxin.
    Stay strong!!

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    Don't give up on your insurance company too quick. Fight the battle on all fronts. Try and get the company to provide the drug for free but also pursue appeals with your insurance company. I highly recommend you check out this web site by Laurie Todd- The Insurance Warrior About Laurie the I.W.

    She is an expert on the insurance appeals process. She has a great book on the subject. If you look around there are also radio interviews with her. She sends the book out pronto if you order it or maybe your local library has it.

    There is a large body of evidence to support an appeal for Rituxan. Work on all of your possiblities at once until one of them comes through.

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    Misskay, it's not necessarily over with Cigna. Your doc shouldn't be throwing in the towel like that. First, find out on what basis they denied it and let us know. It's usually just a matter of appealing and the doc providing proper documentation. Given your problems with ctx they'll approve it.

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    Misskay,
    The insurance companies usually try to deny the first go round with something different your doctor suggests. It is a big game they play and the odds of that person not appealing that decision is large. Call your insurance's medical reveiw department and be very hands on with them. Ask what documention you need to provide in order to reverse this decision. The doctors's office has an easier time with their appeal if you intervene
    because the insurance companies do not want to deal much with the insured. Also, a tip for calling insurances and getting around their phone system is to just keeping asking for a representative, learned that from calling insurance companies for a living. Good luck and Best Wishes!
    jaha

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    Honestly, Misskay, your doctor's office is a key component in the battle on this, particularly since you have already failed ctx. You really have no where else to go in terms of a 'strong' WG drug. Please note that none of the researchers that spoke at the Symposium said they ever have a problem getting this for their patients -- and they deal with insurance companies all over the U.S. When I started treatment, my doc assured me he knew how to 'write the letter' to get rtx approved.

    If nothing else, I'm sure your doctor's office could reach out to a doctor's office at one of the big centers to ask for assistance (hell, he could have them email the boilerplate letter -- I'm sure there is one). This is serious and you shouldn't have to do it on your own.

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    Rhumy called me again... he;s fighting the insurance company. He's told them he will provide any paperwork, lab results, hospital records that they want... but that I NEED this drug. He's *almost* as upset as I am at the situation... he actually called me from his home telephone this evening to talk and make sure I knew he wasn't beat, and to make sure I was ok.

    *EDIT* BTW - I did have a minor come-apart this afternoon. Had a good cry, threw a few pillows... then had a cup of tea. Feeling calmer now. It just makes me so damned mad... we were getting pretty darn close to 'remission' we thought... then the bladder issue cropped up, now this... just scared to death of getting extremely sick again and having to start over from scratch...
    Last edited by misskay; 12-31-2010 at 01:04 PM.

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    Quote Originally Posted by misskay View Post
    Rhumy called me again... he;s fighting the insurance company. He's told them he will provide any paperwork, lab results, hospital records that they want... but that I NEED this drug. He's *almost* as upset as I am at the situation... he actually called me from his home telephone this evening to talk and make sure I knew he wasn't beat, and to make sure I was ok.

    *EDIT* BTW - I did have a minor come-apart this afternoon. Had a good cry, threw a few pillows... then had a cup of tea. Feeling calmer now. It just makes me so damned mad... we were getting pretty darn close to 'remission' we thought... then the bladder issue cropped up, now this... just scared to death of getting extremely sick again and having to start over from scratch...
    It seems the insurance companies often have different standards for outpatient versus inpatient services. If he puts you in a hospital would they cover it then. I know I received Rituxan IV during my hospital stay and don't recall there was any hassle about insurance coverage at that time. Of course I think it was considered a life or death issue then due to hemorrhaging in my lungs.

    With all the stress we have in just dealing with the Wegener's it just seems so unfair that in the USA we often have the extra stress of fighting insurance companies.

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