Medicare Coverage of Avonex
- Thursday, August 6, 2009, 10:10
- Multiple Sclerosis
- 2,630 views
- 1 comment
- Dick:
- Why is Avonex the only one of the ABCR treatments that is currently covered by Medicare?
- Dr. Frohman:
- One of the principal issues has been the difficulty of administering an intramuscular form of a medication. While it’s true that many patients can be very effectively trained to self-administer these drugs, many patients who use Avonex as their disease-modifying agent do not self-inject because of difficulties with the larger needle and the deeper level of penetration. It does require more education, more knowledge and potentially a bit more risk in terms of structures that can be impaled [pierced by the needle] if the injection procedure is not done correctly. [Editor’s note: A “disease-modifying agent” is a medicine that slows or stops the progression of MS. This term distinguishes these medicines from ones that are used to treat acute episodes or relapses of MS, and from medicines that are used just to treat symptoms of MS.] We also know that a number of patients will have [their friend or family member] learn to administer these injections. But, again, in many cases these individuals may not be available. So, there was a lobbying effort by a number of organizations to have Medicare recognize at least this particular administration form of the drug as being one that would be appropriate to offer in a physician’s office.
There are many people who have been injecting themselves or having somebody else inject them [without a problem], and the new legislation does pose challenges for them because in order to get that Medicare coverage, this medication must be administered in a physician’s office.
So, I think the attempt here was really to broaden the umbrella of coverage for many people who either could not inject themselves and other people who had no resources to purchase the medication but now can do so through Medicare.
The other products, Betaseron, Rebif, and Copaxone, all come as pre-filled glass syringes that can be administered through auto injectors. These are much smaller [thinner and shorter] needles. They’re very easy to administer.
- Jan:
- Because it is an intramuscular injection [for Avonex], it is appropriate and often necessary that it be administered [by a professional]. I have several patients that come in daily for those injections that aren’t on Medicare for that very reason. [Editor’s note: These patients avoided accepting Medicare coverage, because their doctors were not allowed to bill Medicare for providing the injection service.] So, to be able to extend it to Medicare patients seems so appropriate and so necessary.
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I AM CURRENTLY ON AVONEX AND ALSO ON MEDICARE. SINCE DECEMBER 2003 I HAVE GONE WEEKLY TO DOCTOR’S OFFICE TO RECRIEVE MY AVONEX INJECTION.
ALL THIS TIME MEDICARE HAS PAID FIOR MY INJECTIONS. HOWEVER IN OCTOBER OF LAST YEAR (2010) THEY HAVE DENIED MY CLAIM. SAYING THAT THEY DON’T COVER AVONEX.
THEY HAVE NEVER NOTIFIED ME AND NOW I HAVE SADDLED WITH A $13,000.00 BILL(FOR 18 WEEKS OF AVONEX TREATMENT). IS THERE ANYTHIING THAT I CAN DO., I HAVE APPEALED MY CLAIM, BIT SO FAR HAVE NOT ANYTHING