Insurances NOT covering AuviQ but still covering Epipen

[ajasfolks2]

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.

[hezzier]

Last time I checked the base pharmacy didn't carry Auvi-Q, but it's been a while since I've checked.  We saw our family doc right before moving and he highly recommended getting some.  He let DS play with the trainer while we were there.

[CMdeux]

United Healthcare hasn't ever moved AuviQ into formulary at all.  We moved to a new Rx coverage this year- Optum-- but they still aren't covering it either.  Epipen twinpacks are at the $50 mid-tier copay.

[SilverLining]

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%.

[spacecanada]

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%.

I guess I have another reason to stay in Alberta (despite my desire to move some place warmer in the winter).  Our private/employer insurance covers both Epipens and Allerject (Auvi-Q) at 80% until we reach the maximum patient payment limit, and then they are both covered at 100%. It makes no sense that one province would cover it but others wouldn't.  Even name brand medications are covered, minus the difference in price from the generic brand.  What is their reasoning for not covering it?  I'm quite saddened by this.   

[SilverLining]

  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. 

[Macabre]

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. 

[QsMommy]

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

[ajasfolks2]

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!

[SilverLining]

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.

[maeve]

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).

[maeve]

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.

[CMdeux]

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.

[SilverLining]

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.

[Michael]

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.