Navigation

Anyone having xolair issues ?

 

So after almost two years of xolair my insurance is denying re authorization. We are still fighting. My doctors office says I’m approved so we will see what happens . So maybe the speciality pharmacy is wrong .Update : Doctors office said they and specialty pharmacy don’t know what’s going on . Speciality pharmacy said they I’m not the only one who is having issues all of sudden . Air quality is horrible in NY right now and I haven’t been on xolair over the time I’m supposed to .

40
88

Comments 40

  • K8sMom2002

    Ugh on the air quality and ugh on the Xolair re-authorization! That stinks that neither the pharmacy nor the doctor's office can figure it out.

    Could you get your doctor's office to do a conference call with you, the specialty pharmacy and your insurance company?

  • BenR

    I’m on the phone with the insurance now there not sure what’s going on either . Finally spoke to NYC healthline  with everyone .  My wife is a teacher so there is multi layered insurance.They are claiming authorization is still pending  and they require more documentation. But my doctors office has a letter saying they gave they info and they have authorization letter and dates .  They said that’s a temporary authorization number that you can’t use.  Work in progress.

  • K8sMom2002

    Aargh … how frustrating! I hope you get it straightened out. Could you reach out to your state's ?

  • BenR

    Now magically they have found the supporting documentation that was sent , but can’t tell me when it will be approved.

  • K8sMom2002

    Well, my gracious! Thank goodness they've found the supporting documentation. But  ugh on no timeline for approval.

    When is your next scheduled Xolair shot?

  • Melissa G

    Uughh, Ben! That is so incredibly frustrating! I am not sure if your insurance company has them, but our insurance agency has "Care Coordinators", you can get assigned to you and they help you with things like this. We had one for over year to help deal with some terrible insurance snafu's. Saved me lots of time and aggravation. 

    I hope this gets figured out quickly. 

  • BenR

    @K8sMom2002. My last scheduled shot was over two weeks ago .   On the plus side if I get completely rejected from my insurance. Xolair has a lot if programs in place.

  • K8sMom2002

    Ben, glad you have a back-up plan in place, but still … I know you want to stay on schedule. Hoping you get to report GOOD news soon!

  • BenR

    I’m  actually going to doctor because I have had a couple asthma attacks and my head is killing me .

  • BenR

    Saw doctor this morning . Took pft . He said my number are lower and my lungs are constricted. MY FEF 25-75 is 98% compared to 125 % a couple of months ago. He said I’m not dying or have to worry in that regard but I have diminished lung capacity.  You never realize how much xolair works for you. He gave me a shot of steroids to help me through until I can hopefully get xolair.  The tests results say I have the lungs of a 75 year old.  On the bright side it’s not as bad as when I had the lung infections and my function went to 35%

  • K8sMom2002

    Oh, my, Ben! I'm hoping you get that Xolair back on board soon and get back to where you were before. That absolutely stinks. Rest up and feel better. So glad you got in to see the doctor. 

  • Melissa G

    Yikes, Ben! How are you feeling today after the steroid shot? Any idea on when you will be able to get the Xolair shot?

  • BenR

    @Melissa G Thanks for asking .  My sinus feel a bit better but it’s a roller coaster ride if I  go outside . Hopefully the air quality improves.

  • BenR

    @Melissa G @K8sMom2002 

    Do you think that the longer I’m off of xolair that the insurance will say your not dead ? You don’t need it ? 

  • K8sMom2002

    Ben, I hear all of your pent-up frustration! Have you heard anything back from your insurance company or your doctor?

    I think many insurance policies have fairly specific criteria for biologics, and it usually comes down to good documentation by both you and your doctor to show that the medication is appropriate for you. It sounds like your doctor is doing a great job of showing what your lung function is without the Xolair.

    The goal for both your doc and for you is to be BETTER. It's to keep you out of the hospital and thriving with well-controlled asthma. And insurance companies have a vested interest in keeping your asthma well-controlled, too — it is cheaper for them to have happy, healthy clients. 

  • BenR

    @K8sMom2002 we are still waiting on insurance.  I do have an appointment with my pcd doctor (pulmonary specialist) on the 11 who well tell me how my lungs are .

  • K8sMom2002

    Ugh on the waiting on insurance, but yay on having an appointment so soon with your pulmonary specialist. 

    If you and your doc have provided all the requested documentation, could you reach out to your state's ? Health insurance is a state-regulated issue, and each state has an agency that investigates cases for their constituents. 

    I hope it doesn't take that … but I have had to go to a state's insurance commissioner before, and they were very supportive. 

  • BenR

    @K8sMom2002 I hope it doesn’t go that far . But my wife is a nyc teacher and the insurance is through her and I don’t want to rock the boat either .

  • BenR

    @K8sMom2002

    Speciality pharmacy says it looks like my insurance has approved my xolair, they haven't shipped anything as of yet . But my doctors office says they have my xolair . I’m so confused but I have an appointment Friday so we will see.

  • K8sMom2002

    Woohoo! That sounds promising! It could be that your doctor's office has one thing of Xolair in stock, and they know yours is coming to replenish their stock. Whatever, I am SO glad that you have this straightened out this far.

    That is so awesome that you hung in there and persisted!

  • BenR

    Thank you . I’m hoping for the best . Thursday is my pcd doctor (pulmonologist) for my checkup will see how my lungs are doing . 

  • BenR

    Kind of sucks . My pcd doctor had to reschedule my appointment to next week . But is going to call me . 

  • BenR

     Every time I open my mouth to talk today,  it feels like there’s sand and nails  in my  throat. Actually it feels like that when I don’t talk either . My chest feels tight and just sucks . Can’t wait for xolair.

  • BenR

    @Melissa G I feel horrible. My glands are swollen in my jaw and I have ear pain .  Last night I was in crazy pain from my ears and the glands in my jaw . Horrible sinus pain now . I’ll see what the doctor says in morning.

  • BenR

    @K8sMom2002 @Melissa G. I got my xolair . Yeah . I’m going to ent now because my ears and swollen glands .

  • Melissa G

    That is fantastic that you have the Xolair! That stinks that you are not feeling well. Good luck with the ENT. Please let us know how the appt goes. 

  • K8sMom2002

    I'm echoing Melissa — great that you have the Xolair, but ugh on being under the weather. I hope your doc can figure things out quickly. What's your asthma sick plan say to do when you feel this way? Anything you can tweak or change to ward off a worse exacerbation?

  • BenR

    @K8sMom2002 @Melissa G

     I’m starting to feel better . But still have asthma attacks. Doctor says I should stay inside . He thinks heat and humidity making it worse . I feel like the xolair has opened my lungs and sinus a bit . I couldn’t get a ent appointment until next Friday. So we will see maybe I won’t need it.

  • BenR

    @K8sMom2002   @Melissa G

    Today they said my lungs sounded good and I should go back inside with ac and stay away from the heat and allergies for my asthma. Also she said to try and not do pfts when I’m sick . She said it’s better do when it’s Normal . I just do what  I’m told I said  . Lol They are going to try and get me a portable nebulizer and 9 % sodium chloride to do during the middle of the day at work or such or to keep my system less dry and more lubrications. Then I can do the medication at home like normal . We will see what ENT says tomorrow.

  • K8sMom2002

    Ben, so glad you have a plan and a new approach to try. I hope the nebulizer with the saline will help!