Premera Approved My Medication, Kesimpta!

I have fantastic news. It feels like a miracle, Premera changed its policy and no longer requires the trial and failure of Ocrevus before Kesimpta, so my medication has been approved! I should be able to get it set up and delivered before my October dose is due.

We aren’t sure if I had anything to do with them changing their rules, or if this was already in the works because we all know it has to do with where the money is, but it is great to know that my meds are now covered. They finally realized that Kesimpta is cheaper to them than Ocrevus. 

The way I found out this great news was a bit odd. I received an email from someone who works for Novartis, the drug company for Kesimpta. I was incredibly confused. At the time I wasn’t sure if it was real because I hadn’t heard directly from Premera, I hadn’t heard from my neurologist’s office, and I was also waiting to hear back from Novartis to see if they would pay for my medicine since Premera wasn’t looking very promising. I spent hours calling around trying to figure out if it was true or not, and sure enough, it was true. Of course, the following day, one of the people I called and left a voicemail with at Premera tried to tell me it hadn’t been approved. I told her she would ruin my day if she took this away from me. She did some research and agreed that it had been approved. And, I did finally get a letter in the mail from Premera letting me know it is approved.

The ironic thing is that the week prior Premera once again had denied my coverage. They redid their last review with medical doctors because we complained that the doctors reviewing my case claimed I didn’t even have Mulitple Sclerosis. They had one new doctor on my review and while they at least didn’t say it couldn’t be covered because I don’t have Multiple Sclerosis, they still had all sorts of medical facts wrong about my case. It just goes to show that some phony people with their medical licenses who are no longer practicing medicine are signing off to help out the insurance companies so they won’t have to pay for coverage of expensive medications. I guess I would not know the outcome if it had gone to the external review. 

Thank you all for your prayers for me in this. It has been an incredibly stressful season making phone calls and fighting to get my meds covered. I had some old friends step in and try to help and just every single prayer lifting me up was felt. If I am being honest, there were some days I wondered if the stress of it all was even worth it. I was starting to get worried I would have a relapse because I was so stressed out. And, my poor kids saw me crying, no wait, bawling on the phone several times. It was hard. But, God provided in the end.

One thing that I found out in the process is that I essentially got screwed over because my neurologist went on vacation. It makes me incredibly angry because my neurologist should be able to take a 2-week vacation and enjoy time away so he can refocus on his clients, but I shouldn’t be hurt in the process. I found out that if he had been in the office he could have requested a peer-to-peer and usually peer-to-peer are more successful in getting medications covered. Since he wasn’t in the office we decided to mail in the appeal. Once we went that route, you were apparently not able to do the peer-to-peer. Incredibly frustrating, but I now know for next time! 

Here is to hoping for another successful year on Kesimpta!