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Ofev and Insurance
Hello…Diagnosed with UIP 5 months ago. Starterd OFEV 3 months ago, and overall have tolerated it very well. I just received notification from Medimpact (our insurance providers benefits adminstrator) saying insurance would no longer cover OFEV as part of the ‘covered medication list’
My insurance is through one of largest medical providers in Wisconsin (my wife works for them) so it floors me that they are removing OFEV from the ‘standard formulary’.
Has anyone else had to fight with Medipact to get OFEV ? Letter says after April 1st, OFEV will be covered at the ‘non-preferred’ cost share under our prescription benefits. I take this to mean the cost will go from a $65 co-pay to who knows what?
I have contacted my pulmonologist to see if there is anything he can do on his end, but just curious if others have run into this same situation.
Thanks
Pete
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2 Replies
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Suddenly, everything insurance-related is getting more and more difficult. I am a St. of WI retiree and found two transplant centers who no longer, as of last month, will accept our good insurance. I do not know about this particular situation, but I do know that it’s disturbing that so many are suddenly having insurance issues. What’s the REAL reason why, I wonder?
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Hi Pete – There are a couple of Foundations that will help with the cost of OFEV. You could try Boringhim-O the maker of OFEV. They have an Open-Door program with someone that can point you in the right direction. 1. is the Patient Advocate Foundation – it helps with the co-pay.
If you have Part D for drugs you need prior authorization for it. The Dr. needs to fill something out. 2. Another is The Assistance Fund – I think they are closed not but sign-up happens in Nov.
Hope this helps. -
I think it may have something to do with this study that was released saying that OFEV was not cost-effective. Their logic also applies to Esbriet as I think the prices are similar. OFEV and Esbriet are the only drugs that the FDA has approved for treating IPF.
I would appeal their decision. Both drugs are on most insurance approved drug listings.
The study can be found at:
https://pulmonaryfibrosisnews.com/2022/01/19/ofev-esbriet-not-cost-effective-ipf-treatment-us-study-reports/
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