CVS/Caremark Formulary Changes for Plegridy and Avonex

Stuart SchlossmanMisc. MS Related, MS Drug Therapies

As some of you may have learned from
correspondence received from CVS/Caremark, effective January 1, 2016,
PLEGRIDY® (peginterferon beta-1a) and AVONEX® (interferon beta-1a) will be
excluded from a subset of CVS/Caremark commercial health insurance plans. This
change will NOT impact all patients who have CVS/Caremark health insurance. 
Therapy decisions are best left to be
determined by patients and their physicians. There are actions that patients
and their physicians can take to ensure that they can remain on their current
therapy. Individuals impacted by CVS/Caremark’s decision can work with
their physicians as follows:

  • The physician can submit
    a medical exception/letter of medical necessity directly to CVS/Caremark
  • If the medical exception
    letter is not successful, an appeal can be filed
  • During the appeal
    process, the patient may be eligible to receive interim doses from Biogen
    to ensure there is no disruption in treatment
  • If
    the appeal is denied, patients may be eligible for Biogen’s patient
    assistance programs
  • Patients that need
    assistance in understanding and navigating their health insurance coverage
    can contact Biogen Support Coordinators at 1-800-456-2255; M-F, 8:30am –
    8:00pm EST
  • Through the support program, Biogen is
    committed to helping patients and provides support services to patients
    and caregivers, such as financial and insurance support, nurse educators,
    support coordination, and peer connections

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
.===================================
Visit our MS Learning Channel on YouTube: http://www.youtube.com/msviewsandnews