Reply To: my rituxin experience

October 7, 2012 at 11:07 pm

Raymond—when i had my infusions i thought i was covered, it wasn’t until a month or so later Anthem BCBS decided they weren’t going to cover.

They  sent a letter saying they would cover only if i had an abnormal antibody  (which I did) they then sent a second letter saying they would only cover if i failed ivig, i showed them that i had failed all three, ivig, prednisone and plasma x/c.  After I showed that i met their listed criteria they sent a third letter saying they wouldnt cover rituxin for cidp, this time they left out the criteria I had met.   Mine is in the first level appeal process right now, I plan on taking it to the Maine state insurance bureau if they deny the first level appeal.

I think it really depends on where you live, i guess if i had lived in MA it would have been covered just on the fact that it’s the immunosuppressant my dr felt would work best for me…..but the healthcare system in MA is waaay better and ahead of the system in Maine.  In Maine the people who receive the free government insurance–mainecare, get a lot better coverage than us who work and have to pay for our insurance—our’s is a very messed up system right now 🙁   hopefully if you live in a state where insurance is better and your dr feels you need rituxin you might not have a problem getting it.

have you already failed ivig and prednisone?  they are suppose to be safer than the rituxin.  Although so far, i have  not had any negative side effects from it.  I have been without ivig since May— 5 months with no worsening of symptoms.   I have not had significant strength  increase, my dr said it may take a while to see that??     good luck with it—-dealing with insurance companies can be very stressful!!!