More good news regarding Tysabri!!! ...
Medicare is covering the cost 100% under Part B: Medicare October 1st price adjustment document for natalizumab HPCS Code 4079 (see 540 to the left of spreadsheet or Q4079)
See link to the right. To view, you must accept the Licensing Agreement (that allows you to proceed) then zipped file will download and extract as an Excel spreadsheet, which breaks down as: Covered $7.719 per 1 mg = 7.719 x 300 mg = $2,315.70 or 100% with no pre-authorization required!.
AND it's covered by Medicaide/Medi-Cal too! See: Official bulletin link to the right re: HPCS code update. Each state will receive or has already received a similar notice for the Medicare HPCS quarterly update to the approved Medicare formulary. What happened on Oct 1st was a systematic IMPROVEMENT in the Medicare approval process, not a road block or a traffic jam.
As an aside, listed is an older study that was performed to help determine a U.S. cost analysis of an MS patient receiving managed health care because of a "relapse" or exacerbation that brings the patient into the doctor's office, hospital, ER, or clinic. Cost of managing an episode of relapse in multiple sclerosis in the United States...see link to the right. This study was probably used to determine a cost analysis of a relapse and possible justification for continuing Medicare coverage of then currently FDA approved medications for MS such as the interferons and GA.
With Tysabri now available to the MS community it is my shared opinion with other MS patients that U.S. health care providers and insurers will now be getting thier money's worth as compared to the previously FDA approved MS medications. The better news is that MS patients and their prescribing TOUCH physicians will have a superior first line OR rescue medication available for active or inflammatory MS with outstanding efficacy and genuine quality of life benefit in most cases until the actual cure is discovered for MS.
More updated data just released re: Tysabri coming up in my next post...it's exciting data!!!
Medicare is covering the cost 100% under Part B: Medicare October 1st price adjustment document for natalizumab HPCS Code 4079 (see 540 to the left of spreadsheet or Q4079)
See link to the right. To view, you must accept the Licensing Agreement (that allows you to proceed) then zipped file will download and extract as an Excel spreadsheet, which breaks down as: Covered $7.719 per 1 mg = 7.719 x 300 mg = $2,315.70 or 100% with no pre-authorization required!.
AND it's covered by Medicaide/Medi-Cal too! See: Official bulletin link to the right re: HPCS code update. Each state will receive or has already received a similar notice for the Medicare HPCS quarterly update to the approved Medicare formulary. What happened on Oct 1st was a systematic IMPROVEMENT in the Medicare approval process, not a road block or a traffic jam.
As an aside, listed is an older study that was performed to help determine a U.S. cost analysis of an MS patient receiving managed health care because of a "relapse" or exacerbation that brings the patient into the doctor's office, hospital, ER, or clinic. Cost of managing an episode of relapse in multiple sclerosis in the United States...see link to the right. This study was probably used to determine a cost analysis of a relapse and possible justification for continuing Medicare coverage of then currently FDA approved medications for MS such as the interferons and GA.
With Tysabri now available to the MS community it is my shared opinion with other MS patients that U.S. health care providers and insurers will now be getting thier money's worth as compared to the previously FDA approved MS medications. The better news is that MS patients and their prescribing TOUCH physicians will have a superior first line OR rescue medication available for active or inflammatory MS with outstanding efficacy and genuine quality of life benefit in most cases until the actual cure is discovered for MS.
More updated data just released re: Tysabri coming up in my next post...it's exciting data!!!
(((hugs)))
Love, Lauren
A very proud member of www.MSpatientsforchoice.org
posted by Lauren @ 5:09 PM
1 Comments:
At 4:11 PM,
Anonymous said…
WOW Lauren! Does that means I won't have my current $90 copay? If that's whats going to happen I am really excited!!!
I will hold my breath until I'm sure. My next infusion is in one week.
Penny
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