Promacta cost/coverage

Presently on 50mg Promacta, diagnosed 2 months ago, past two weeks, count 172, 143. Last dose of dexa 20 mg x 4 days finished day before 172 count. Insurance denied coverage of Promacta today stating I did not meet criteria since corticosteroids, IVIG and spleenectomy has not failed. What are resources to obtain financial assistance or coverage for promacta? Any suggestions greatly appreciated.

I know nothing about Promactal, thankfully - but have you checked their website?
www.us.promacta.com/chronic-itp/about-the-disease/itp-symptoms/?site=43700032918329623&source=01030&irmasrc=PRMWB27247&gclid=EAIaIQobChMIwPGoup_L5wIVTdbACh136Av5EAAYASAAEgJokfD_BwE&gclsrc=aw.ds

This is from the site - that part in red I made red because it kind of says what your insurance company said:
"Approved Uses for PROMACTA® (eltrombopag) Tablets
PROMACTA is a prescription medicine used to treat adults and children 1 year and older with low blood platelet counts due to chronic immune thrombocytopenia (ITP) when other medicines to treat your ITP or surgery to remove the spleen have not worked well enough. PROMACTA is used to try to raise platelet counts in order to lower your risk for bleeding."

It also says: "PROMACTA is not used to make platelet counts normal."

I take NPlate, and the prescribing info is the same as what Mel describes for Promacta.
However, I haven't had splenectomy. Steroids work well for me, but aren't an option anymore because of the damage they were starting to cause. I've never had IVIG, but that isn't a permanent fix anyway. Despite all that, my insurer did approve NPlate without any reservations. Perhaps that's because I wasn't newly diagnosed (8 years or so past diagnosis), or maybe it's just the difference in insurance policy rules. Hard to know. But with enough justification from a good physician, it's not impossible to get these drugs approved without those first treatment hurdles being crossed.

There are patient copay assistance programs, but you'd have to ask the company if anything is available outside of the insurance route. And even if there is, they might want you to first have tried surgery and the other more damaging meds.

JMohr- hello, I was on Promacta several times and also on the patient co-pay program. Promacta was owned by GlaxoSmithKline then but has since been sold to Novartis- so my experience may be different from the Novartis program. you'd have to check it out. When I was on the program Promacta was paid 100%. Only requirement was that my income was under $75,000. per year. I have not had a splenectomy or IVIG. My hemo's office set me up in the program and did all the paper work.

Are you sure the insurance requirements are steroids, IViG, AND splenectomy?. Because what I've seen is the requirements are steroids, IViG OR splenectomy. Before getting on Nplate, which is another drug similar to Promacta and very expensive, my insurance required me to try 3 treatments and splenectomy was suggested but not required. I had tried prednisone, dexamethasone and Rituxin so I qualified.

I had a response to each of the 3 treatments but when the drug was stopped my counts dropped. So I had "failed" that treatment, failed to attain remission is what they mean. It sounds like you may not have actually "failed" dexamethasone if your counts were 172. Probably allowing your counts to drop to below 30 would be considered failure.

I had to write an appeal and my hemo's office had to fight Blue Cross to get Nplate paid for. It was very stressful because I was getting the drug and racking up huge bills but not sure if it was going to be paid for. Blue Cross finally agreed to pay. I switched insurance and my new insurance has been much better. They have never complained at all, they just paid right away after my deductible was met. The Nplate/ Amgen co-pay program has paid my deductible of $6500. per year which has been a great help.

If you want Promacta, my advice is to not give up. You deserve to have a drug that works without side effects. Thats what everyone wants! Good that you found something, you deserve to have access. But you may have to jump through some hoops. Good luck!

Jmohr316, I failed to achieve remission with a single Dex treatment. Then failed to achieve remission with a single IVIG treatment. Then refused Splenectomy. I think mere refusal is enough but I also gave a reason that it statistically doesn't work as often for older folks - like me. As I understand, that was enough for insurance 'prior approval'.

Also, try this page. Then go down to the 'Ways To Save On Your Eltrombopag Prescription' section for a list of what is available.
www.goodrx.com/eltrombopag

On a side note. Now that the ASH recommendations on ITP treatment have been recently updated, the rules may change in the near future for what it takes to get prior approval.