Prior authorization

Quote from: momma2boys on April 27, 2015, 02:29:12 PM
Ugh, my insurance now requires PA on Auvi-q

Does PA means physicians authorization?  or prior authorization?

I'm only asking because I am hitting that with other medications and because of that my allergist was surprised we did not need it for Auvi Q.  We need it for Ventolin (they will only cover Pro Air without it - and pro air causes DD to shake like crazy so this one went through easily), Nasonex (since there are now 2 over the counter options) and for Elidel (I'm not sure why on this one).

Ugh, my insurance now requires PA on Auvi-q

Quote from: LinksEtc on August 11, 2014, 04:49:48 PM
I haven't verified.


"Obtaining Auvi-Q Epinephrine Auto-injectors - Problems and Solutions"
http://www.amazingandatopic.com/2014/08/obtaining-auvi-qs.html

QuoteAs of 1/1/2015, the Auvi-Q will return to the Express-Scripts Formulary, as a "Tier 2" medication, meaning it should be covered by most insurance plans! They were finally able to overcome the exclusivity contract brokered by another epinephrine manufacturer, and now freedom of choice has been restored to families in search of epinephrine! This change has already taken place with Caremark, as of 7/1/2014.

OH I HOPE so!

I haven't verified.


"Obtaining Auvi-Q Epinephrine Auto-injectors - Problems and Solutions"
http://www.amazingandatopic.com/2014/08/obtaining-auvi-qs.html

QuoteAs of 1/1/2015, the Auvi-Q will return to the Express-Scripts Formulary, as a "Tier 2" medication, meaning it should be covered by most insurance plans! They were finally able to overcome the exclusivity contract brokered by another epinephrine manufacturer, and now freedom of choice has been restored to families in search of epinephrine! This change has already taken place with Caremark, as of 7/1/2014.

UHC covered the Auvi-Q last year, so we got one.  I must say I much prefer the Auvi-Q to the Epipen because of the size.  We did not have a problem with early expiration.  We got ours last year and it is good through the end of this year.  However, now with UHC you have to get prior authorization.  Basically our doctor has to call them and convince them that Epipen is not an acceptable replacement, which is probably impossible as it is the same drug in the end.  Anyway, it looks like the difference in price is about $50 (~$400 for the Auvi-Q vs ~$350 for the Epipen).  Factoring in a difference in co-pays and the extra cost to UHC is about $30 (which I would gladly pay!, but that is not how the system works).  It looks like Auvi-Q needs to come down in price some or they will get run out by Epipen just because of this insurance issue.

Quote from: maeve on July 01, 2014, 10:07:12 AM

Quote from: ajasfolks2 on July 01, 2014, 06:23:39 AM
Wondering what the cost difference is to the insurance(s) -- likely different with each, based on negotiations pharma-insurance -- between AuviQ and Epipen?  There's some serious behind-the-scenes work (and cost negotiations!!) going on by Epipen to get their products higher up on the ladder of acceptance, is my guess . . .

And AuviQ is going to have to STEP UP and push hard to get their device on formulary for many companies . . .

AuviQ is more likely to be carried by teens/tweens/and adults due to size and shape, as well as ease of use IMHO.  I'd like to see a survey/study done to support this opinion, TYVM!

I had posted a link to a couple of threads from a pharma sales rep board that discussed the marketing issues with Auvi-Q. These were Sanofi reps discussing the issue. There are a lot of factors at work. Most insurance plans will only cover another such device if it demonstrably improves or is different than the drug already covered, so if it's not going to be covered doctor's are less likely to prescribe (and think how many people who have EpiPens aren't even prescribed those now). Then there's been an issue with expiry with Auvi-Q, so pharmacies are less likely to stock it if the stock is going to perish before it can be sold.  I'm considering purchasing and Auvi-Q out of pocket for DD (at a cost of nearly $400) because of the form factor but I'm reluctant to do so when I've heard of people getting Auvi-Qs that have an expiry of less than a year from date of purchase.

My pharmacy does not keep either in stock because they expire, or get to close to the expiry date.  They order it in for me, and it takes a day to get it in.  One time, the pharmacist called me to say the one delivered to her was only good for three months.  She knew I wouldn't accept that and was fighting with them.

The other reason which could compel coverage would be a study demonstrating less costly OUTCOMES as a result of AuviQ-- that is, the form factor encourages carrying, which reduces the likelihood of long-term care due to oxygen deprivation, etc. during a reaction that goes untreated too long.

The problem for us here is that such outcomes are quite RARE as of yet, so actuarial considerations haven't tipped the scales in favor of one device over the other, though I anticipate that will eventually be the case.

Just in sheer hospitalizations versus ER discharges, it seems to me that it is likely to matter.  Eventually that will become clear.  I have little doubt that those numbers are being (or will be) collected and tabulated and analysed at some point, and THEN it will be clear to insurers and employers who are hiring them that the cost factor up front is a wash, but that they are FAR less likely to have big payouts to patients who need the device if they, you know-- actually CARRY it.

This has happened with asthma medications, by and large.  That is a larger patient population, but I can recall having to truly fight for coverage of a luekotriene receptor antagonist when it was new(ish) as a therapeutic class.

Quote from: ajasfolks2 on July 01, 2014, 06:23:39 AM
Wondering what the cost difference is to the insurance(s) -- likely different with each, based on negotiations pharma-insurance -- between AuviQ and Epipen?  There's some serious behind-the-scenes work (and cost negotiations!!) going on by Epipen to get their products higher up on the ladder of acceptance, is my guess . . .

And AuviQ is going to have to STEP UP and push hard to get their device on formulary for many companies . . .

AuviQ is more likely to be carried by teens/tweens/and adults due to size and shape, as well as ease of use IMHO.  I'd like to see a survey/study done to support this opinion, TYVM!

I had posted a link to a couple of threads from a pharma sales rep board that discussed the marketing issues with Auvi-Q. These were Sanofi reps discussing the issue. There are a lot of factors at work. Most insurance plans will only cover another such device if it demonstrably improves or is different than the drug already covered, so if it's not going to be covered doctor's are less likely to prescribe (and think how many people who have EpiPens aren't even prescribed those now). Then there's been an issue with expiry with Auvi-Q, so pharmacies are less likely to stock it if the stock is going to perish before it can be sold.  I'm considering purchasing and Auvi-Q out of pocket for DD (at a cost of nearly $400) because of the form factor but I'm reluctant to do so when I've heard of people getting Auvi-Qs that have an expiry of less than a year from date of purchase.

Quote from: ajasfolks2 on June 28, 2014, 01:13:26 PM
Am reading some comments on FB that some major insurance companies are dropping coverage for AuviQ but still keeping coverage for Epipen.

I have some theories on this, but am wondering if some here have also discovered this?


I think I recall seeing that Anthem was one insurance that was dropping.

I'll try to post other insurance names as I recall or read again.

I guess it depends on which version of Anthem you have because my insurance never covered it. Then again my prescription insurance has been with Medco (didn't cover it) and now Optuum (also doesn't cover it).

Quote from: QsMommy on June 30, 2014, 01:38:52 PM

Quote from: SilverLining on June 28, 2014, 03:48:02 PM
CANADA SPECIFIC

Most insurance coverage here is based on provincial coverage.  In Ontario Auvi-Q have never been covered. neither was twinject.  Our private policy covers epi-pen at 90% because it is covered by provincial here? Auvi-Q is either not covered at all, or probably covered at 50%.

If I lived in Alberta, covered under the same company policy I have here, both epi-pen and Quvi-Q would be covered at 90%.

Interesting, I'm in Ontario and my private health policy has covered Allerject (Auvi-Q) at 80% since last year.

Ali

Your policy is not based on the provincial than.  I find it interesting that co-workers of my husband that live in different provinces have different coverage under the same policy.

Wondering what the cost difference is to the insurance(s) -- likely different with each, based on negotiations pharma-insurance -- between AuviQ and Epipen?  There's some serious behind-the-scenes work (and cost negotiations!!) going on by Epipen to get their products higher up on the ladder of acceptance, is my guess . . .

And AuviQ is going to have to STEP UP and push hard to get their device on formulary for many companies . . .

AuviQ is more likely to be carried by teens/tweens/and adults due to size and shape, as well as ease of use IMHO.  I'd like to see a survey/study done to support this opinion, TYVM!

Quote from: SilverLining on June 28, 2014, 03:48:02 PM
CANADA SPECIFIC

Most insurance coverage here is based on provincial coverage.  In Ontario Auvi-Q have never been covered. neither was twinject.  Our private policy covers epi-pen at 90% because it is covered by provincial here? Auvi-Q is either not covered at all, or probably covered at 50%.

If I lived in Alberta, covered under the same company policy I have here, both epi-pen and Quvi-Q would be covered at 90%.

Interesting, I'm in Ontario and my private health policy has covered Allerject (Auvi-Q) at 80% since last year.

Ali

Fwiw Anthem is BCBS. It's what they call it in and around Virginia.

Our BCBS (our of Pennsylvania) does not cover it (DH and DS are in it), but my PHCS/MultiPlan does. 

Quote from: spacecanada on June 28, 2014, 11:14:22 PM
  What is their reasoning for not covering it?  I'm quite saddened by this.   

The government reasoning?  They cover ONE, and since epi-pen has been around longer, that's the one they cover.

It think there are a few things about the Alberta policy that is better than Ontario's.