January 14, 2022 at 4:16 pm #30756
My pulmonologist prescribed esbriet in October, 2021. I have not been able to get an approval for this drug to be filled. Has anyone experienced this. Can you give me some pointers on how I can get this prescription approved?
January 18, 2022 at 2:34 pm #30774William KrackeParticipant
I have a similar issue with my insurance (TRICARE for LIFE as retired military). They use Express-Scripts for all drug transactions and I have to get a form filled out by my pulmonologist and sent into them to get the prescription approved. The approval lasts for a year and I have to go through the whole approval process again. While this may not be quite the same situation as yours I would recommend looking at your insurance company’s formulary for Esbriet and seeing if there is any information there about pre-approval and if not contact them directly or check with the pharmacy to determine what they need to get approval. They just want to make sure you really need it because it is expensive.
Hope that helps.
January 18, 2022 at 4:08 pm #30775Kathleen KaufmanParticipant
I’m fairly certain Esbriet is Medicare approved, and some insurance companies have a policy that they’ll approve what Medicare approves. I’d certainly use that as an argument.
January 18, 2022 at 8:20 pm #30777Midge SanfordParticipant
When my Medicare Part D Insurance did not cover Esbriet, my pulmonologist’s pharmacy (at Cedar’s Sinai in Los Angeles) got me in touch with Genentech, the manufacturer, and I have been getting the medication for FREE for the last year and a half or so. Good luck! See below:
Genentech Patient Resource Center
Our center dedicated to getting patients and caregivers to the right resources.
Call us at (877) 436-3683 or (877) GENENTECH, Monday-Friday, 6am-5pm PT.
Genentech Access Solutions
This service offers coverage support, patient assistance, and other useful information.
Genentech Patient Foundation
Provides free medicine to patients without insurance coverage or who can’t pay for their Genentech medicine.
Provides additional resources and information.
January 18, 2022 at 11:07 pm #30785
Thank you for your feedback! I will research with Genentech.
January 20, 2022 at 4:05 pm #30817BrendaParticipant
Brenda Colvin. I read an article saying Esbriet and Ofev are not cost effective in the U.S. is that true or do most of you live out of the states. I know it’s expensive but didn’t we wouldn’t have access to it here. I live in Florida. Not on medication yet but want to know options when time comes.
January 24, 2022 at 9:13 pm #30837
Hi Brenda, I live in the states and I’m having a hard time getting the prescription filled. My doctor has now changed my medication to Ofev. I guess he thinks they might fill one over the other. Even though Ofev is supposed to be cheaper it’s still expensive so we’ll see how I make out.
January 26, 2022 at 1:43 am #30851MarianneParticipant
Hi all –
Not sure but think both Esbriet and OFEV require prior authorizations before patients can get either of these medications. I live in the US. I have been on OFEV for 2 1/2 years and I have a prior authorization that is good through the end of 2022. I assume this is something your doctor fills out to show that you medically “qualify” for these drugs. Both these drugs are very similar in costs and co-pays are very high. I am on Medicare but was not when I began taking this OFEV and the co-pays were very high. Hope this helps.
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