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Entyvio Coverage - NYState

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Posted 12/12/2017 6:04 PM (GMT 0)
This is a financial question—I hope this is okay to post here,—I have exhausted all my other resources.

I live in New York State. I purchased insurance (Empire BlueCross BlueShield) through the Marketplace (Obamacare) for the past year which covered my Entyvio infusions for 2017. They will not be covering it for 2018. I have called every insurance company offering Marketplace plans and NO ONE is covering Entyvio.

Has anyone else had this problem? Has anyone applied to the patient assistance program that the drug company provides? Have they had success? I am so worried that I will be denied and have to pay the full price of Entyvio (which you all know is insanely high). The mentioned that my income is a little bit higher than they would like but they didn't give me an income cut-off number....

Anything information would be helpful! Entyvio has been a miracle drug for me.
Posted 12/12/2017 6:38 PM (GMT 0)
They don't really have a PAP program I don't think. I believe it's copay assistance. PAP is for uninsured.

/www.entyvio.com/financial-support

I used entyvio connect to help pay the costs for my infusions, but it was very difficult to get the program to pay. They wanted all sorts of documentation from my facility and I had a ton of trouble getting the hospital to provide what they wanted. It literally took me about 50 calls to a variety of people over the course of months. Not to be discouraging... Once i got it managed, it was easy enough. They said I was the first person at my facility to use the program. Hopefully all the leg work I did provided an easier process for future applicants.

I haven't heard of people having trouble getting covered though. I was only on the drug for a few months. All that work to get the payments, and then I only needed them 2x, but the cost would have been astronomical, so it was worth it.
Posted 12/12/2017 6:51 PM (GMT 0)
they might say not covered, but under appeal it could get coverage. sucks no way to be sure in advance.

I would triple confirm the old plan is dropping coverage. maybe there is an appeal process there.

did they drop all infusions, or just this drug?
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