View Single Post
  #2  
Old Wed Jun 15, 2011, 11:57 PM
Neil Cuadra Neil Cuadra is offline
Owner
 
Join Date: Jul 2006
Location: Los Angeles, California
Posts: 2,553
Sally,

I'm sorry you've run into this situation. It's a problem that many patients have faced: one immunosuppressant is Medicare-approved for aplastic anemia and one is not, leaving doctors and patients in a bind when one is medically appropriate as a replacement for the other.

When your Medicare Part D plan doesn't cover a drug, the first thing to do is to see if another available plan does. Each prescription plan provider has their own formulary of drugs they cover. However, the Medicare Plan Finder seems to show that none of the California plans cover Prograf.

I suggest contacting any or all of the following groups to see if they can help you:
  1. Your doctor, to see if there are other choices for your treatment or if you really need to use a non-covered drug.

  2. Your hospital or treatment center, to see if they have a program to help patients when Medicare doesn't cover a drug your physician has prescribed.

  3. Astellas, maker of Prograf, about their Patient Assistance Program.

  4. The Georgetown Health Policy Institute, in case they can give you advice or direct you to resources. I've mentioned them because they've sent representative to AA&MDSIF patient conferences so I know they have an interest in helping patients, not just doing research.

  5. Medicare and/or your Plan D prescription provider, to go through their appeals process. Appeals can be a lot of trouble but those who persevere sometimes get coverage for drugs that were initially denied.
Good luck. Please post again to let us know what happens.
Reply With Quote