Neupogen coverage -insurance nightmare

hello ladies, I am writing to get some input. I am a patient Dr. Braverman, and Neupogen has been prescribed to me (to help with IUI and hopefully sustain a pregnancy). One vial of Neupogen can cost $375-$400 (I go through 1-2 vials a week). Right now I was blessed to receive 1 donated vial from Dr. Braverman's office as well as several vials from generous patients who no longer need the drug. Each of these patients had coverage for the drug (and had co-pays of ranging between $5.00 and $150). I will run out of the drug within the next 5-6 weeks. My insurance company (United Health Care and Caremark CVS) denied coverage for Neupogen stating that my diagnosis was considered "un-provable." The diagnosis code that Dr. Braverman's office gave to the insurance company was code 279.40 "auto-immune disorder/deficiency." If the right diagnosis code is used, then the insurance company just may reconsider my coverage (at which time my co-pay would be $30 for a box of 10 vials -which is worth $4,000). Does anyone have any insight, recommendations on how to negotiate the insurance nightmare? how to advocate for oneself to receive coverage? Should I ask Braverman's office to appeal this denial (appeal process can take months) and I am not confident that Braverman's staff have the time to do this. Thanks for any advice. Emmy

Re: Neupogen coverage -insurance nightmare

I had united healthcare 2yrs ago ( I now have GHI) and I have caremark cvs now. When I had united they really wouldnt cover much of anything except dr visits but they did pay for all my meds. I would ask the drs office if they can change the code so that your insurance will pay, some are really nice about it and will do it to help you out. I have GHI now (under my husband) and they paid for all my meds and all Caremark would pay for was progesterone and medrol. CVS tends to be really strict when it comes to fertility meds but they do have a special dept that deals with fert meds you should call them and ask if you would get a lower rate with them. Its called there specialty pharmacy.