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Author Topic: Insurance refusing to cover Sensipar  (Read 7243 times)
Deanne
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« on: March 09, 2011, 07:16:04 AM »
My neph wants me on Sensipar, but my insurance company is refusing to cover it.  :thumbdown; Any suggestions?
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Deanne

1972: Diagnosed with "chronic kidney disease" (no specific diagnosis)
1994: Diagnosed with FSGS
September 2011: On transplant list with 15 - 20% function
September 2013: ~7% function. Started PD dialysis
February 11, 2014: Transplant from deceased donor. Creatinine 0.57 on 2/13/2014
paul.karen
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« Reply #1 on: March 09, 2011, 08:48:28 AM »
Stupid insurance companies know better then our doctors.

Have your Neph write them a note stating you need this drug.
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Curiosity killed the cat
Satisfaction brought it back

Operation for PD placement 7-14-09
Training for cycler 7-28-09

Started home dialysis using Baxter homechoice
8-7-09
willowtreewren
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My two beautifull granddaughters

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« Reply #2 on: March 09, 2011, 11:40:28 AM »
Ask your social worker for a coupon. Reduces the cost to a few dollars.  :2thumbsup;
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Wife to Carl, who has PKD.
Mother to Meagan, who has PKD.
Partner for NxStage HD August 2008 - February 2011.
Carl transplanted with cadaveric kidney, February 3, 2011. :)
Deanne
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« Reply #3 on: March 09, 2011, 12:59:32 PM »
I don't have a social worker yet. My neph gave me a Sensipar pharmacy card to use (is that the coupon you mean?), but apparently it's use still requires my insurance company's approval and they refused it. I have a call in to my neph. I'm hoping I can just keep using calcitrol instead.
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Deanne

1972: Diagnosed with "chronic kidney disease" (no specific diagnosis)
1994: Diagnosed with FSGS
September 2011: On transplant list with 15 - 20% function
September 2013: ~7% function. Started PD dialysis
February 11, 2014: Transplant from deceased donor. Creatinine 0.57 on 2/13/2014
willowtreewren
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My two beautifull granddaughters

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« Reply #4 on: March 09, 2011, 01:45:55 PM »
Quote
I don't have a social worker yet. My neph gave me a Sensipar pharmacy card to use (is that the coupon you mean?), but apparently it's use still requires my insurance company's approval and they refused it. I have a call in to my neph. I'm hoping I can just keep using calcitrol instead.

ARGH!!!  :banghead; :banghead; :banghead;
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Wife to Carl, who has PKD.
Mother to Meagan, who has PKD.
Partner for NxStage HD August 2008 - February 2011.
Carl transplanted with cadaveric kidney, February 3, 2011. :)
KarenInWA
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« Reply #5 on: March 09, 2011, 03:05:42 PM »
All I can say is I HATE HATE HATE HATE HATE being sick in the USA....

 :rant;

Sorry to hear this Deanne.  Like we need this kind of stress!  :grouphug;

KarenInWA
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1996 - Diagnosed with Proteinuria
2000 - Started seeing nephrologist on regular basis
Mar 2010 - Started Aranesp shots - well into CKD4
Dec 1, 2010 - Transplant Eval Appt - Listed on Feb 10, 2012
Apr 18, 2011 - Had fistula placed at GFR 8
April 20, 2011 - Had chest cath placed, GFR 6
April 22, 2011 - Started in-center HD. Continued to work FT and still went out and did things: live theater, concerts, spend time with friends, dine out, etc
May 2011 - My Wonderful Donor offered to get tested!
Oct 2011  - My Wonderful Donor was approved for surgery!
November 23, 2011 - Live-Donor Transplant (Lynette the Kidney gets a new home!)
April 3, 2012 - Routine Post-Tx Biopsy (creatinine went up just a little, from 1.4 to 1.7)
April 7, 2012 - ER admit to hospital, emergency surgery to remove large hematoma caused by biopsy
April 8, 2012 - In hospital dialysis with 2 units of blood
Now: On the mend, getting better! New Goal: No more in-patient hospital stays! More travel and life adventures!
paris
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« Reply #6 on: March 09, 2011, 04:25:56 PM »
I get frustrated with all of it.  But, my expenses for surgery and all that went with it, comes close to $200,000.  We have had to pay a few hundred.  I can't complain because I know others have it so much worse.  I had top ranked surgeons, private room, 1 day in ICU, chemo, and on and on.  This isn't a cheap disease and the anti rejection meds are very expensive.  My doctors insist on brand names for Cellcept and Prograf.  I am ok with that.  The surgeon sent a note to insurance company and pharmacy stated that brand name is  "medically necessary".  See if yours will do that.  It might help.   I'm sorry. None of us need this extra stress and worry.   :cuddle;
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It's not what you gather, but what you scatter that tells what kind of life you have lived.
sutphendriver
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« Reply #7 on: March 09, 2011, 04:35:04 PM »
Might try Zemplar too, some times they cover one but not another...different pharm company's I guess.
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paris
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« Reply #8 on: March 09, 2011, 04:36:29 PM »
Quote from: sutphendriver on March 09, 2011, 04:35:04 PM
Might try Zemplar too, some times they cover one but not another...different pharm company's I guess.

You are so right!
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It's not what you gather, but what you scatter that tells what kind of life you have lived.
greg10
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« Reply #9 on: March 09, 2011, 04:51:06 PM »
Quote from: Deanne on March 09, 2011, 07:16:04 AM
My neph wants me on Sensipar, but my insurance company is refusing to cover it.  :thumbdown; Any suggestions?
I am sorry to hear about your situation.  Could you explain your condition a little more and why your nephrologist is prescribing Sensipar.  Sensipar is not a wonder drug and it is not generally indicated for someone not on dialysis.
"Sensipar is NOT approved (nor does Amgen support its use) for patients who are not on kidney dialysis"

BTW, it appears that even in Canada, you may have problem getting Sensipar under some circumstances:
http://www.dialysis-do-or-die.com/2010/12/unafordable-sensipar-for-dialysis.html

Amgen Sensipar pharmacy card to reduce copay.  This still requires the insurance company to pay up to $5000 per year per patient, it only reduces the copay for the patient for up to $3000.  Sensipar just costs too much.

Generic Sensipar has been denied in the US until at least 2016:
http://www.bloomberg.com/news/2011-01-07/amgen-wins-ruling-against-teva-in-generic-sensipar-fight.html
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Newbie caretaker, so I may not know what I am talking about :)
Caretaker for my elderly father who has his first and current graft in March, 2010.
Previously in-center hemodialysis in national chain, now doing NxStage home dialysis training.
End of September 2010: after twelve days of training, we were asked to start dialyzing on our own at home, reluctantly, we agreed.
If you are on HD, did you know that Rapid fluid removal (UF = ultrafiltration) during dialysis is associated with cardiovascular morbidity?  http://ihatedialysis.com/forum/index.php?topic=20596
We follow a modified version: UF limit = (weight in kg)  *  10 ml/kg/hr * (130 - age)/100

How do you know you are getting sufficient hemodialysis?  Know your HDP!  Scribner, B. H. and D. G. Oreopoulos (2002). "The Hemodialysis Product (HDP): A Better Index of Dialysis Adequacy than Kt/V." Dialysis & Transplantation 31(1).   http://www.therenalnetwork.org/qi/resources/HDP.pdf
gothiclovemonkey
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« Reply #10 on: March 09, 2011, 08:35:58 PM »
i too was denied the sensipar, and it led to me getting a parathyroidectomy. My insurance covered it, then when i switched to a new pharmacy, they said it wasnt covered, called dr ,but he never did a damn thing about it, now ive switched to yet another pharmacy, and half the meds i was told were denied, are accepted here! so u may check another pharmacy... good luck!
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Deanne
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« Reply #11 on: March 10, 2011, 08:25:30 AM »
I checked with Medco directly - my prescription coverage. Their website states up-front that they won't cover it, so I don't think the issue is with the pharmacy. 

My neph wants me on Sensipar because, although I'm not on dialysis yet, my PTH is still very high. I don't remember the exact number, but she wasn't pleased. I left a message asking her if I can just make do with Calcitrol for now and see what happens after I start vitamin D (just got a prescription for it). 
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Deanne

1972: Diagnosed with "chronic kidney disease" (no specific diagnosis)
1994: Diagnosed with FSGS
September 2011: On transplant list with 15 - 20% function
September 2013: ~7% function. Started PD dialysis
February 11, 2014: Transplant from deceased donor. Creatinine 0.57 on 2/13/2014
sullidog
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« Reply #12 on: March 10, 2011, 02:33:05 PM »
Have you talked to your insurance and asked them about it? I would talk to them directly to seek out their reasoning.
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May 13, 2009, went to urgent care with shortness of breath
May 19, 2009, went to doctor for severe nausea
May 20, 2009, admited to hospital for kidney failure
May 20, 2009, started dialysis with a groin cath
May 25, 2009, permacath was placed
august 24, 2009, was suppose to have access placement but instead was admited to hospital for low potassium
august 25, 2009, access placement
January 16, 2010 thrombectomy was done on access
MooseMom
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« Reply #13 on: March 10, 2011, 04:25:33 PM »
I think greg may be right.  I'd ask your neph about the difference between Sensipar and Zemplar.  Hyperparathyroidism can be treated with a vitamin D analog (Zemplar) and may be safer than Sensipar.  This may be a blessing in disguise and may be why the ins co denied coverage for Sensipar, ie, you are not a dialysis patient.
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"Eggs are so inadequate, don't you think?  I mean, they ought to be able to become anything, but instead you always get a chicken.  Or a duck.  Or whatever they're programmed to be.  You never get anything interesting, like regret, or the middle of last week."
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