Re: SynVisc - THANK YOU ALL

[Guest guest]

A friend of mine was checking into Synvisc last time we visited with one another

and she found that her Medicare Part D provider did not cover either the regular

Synvisc OR the Synvisc one injectable medication.

I am not sure if she ended up getting it or not. Have not see her in awhile. It

was a big chunk of money she would have to come up with and last I heard she had

not contacted the doc to see if his services would be covered or not by Medicare

Part B.

So just be sure to check all the coverage issues out first so you don't end up

in some unknown for certain monetary situation.

LEANN

>

> I appreciate everyone's response to my question about SynVisc. I like the

idea of trying SynVisc One, and will look into that. I have scheduled my

surgery for October, so I have some time to try the injections, and maybe delay

surgery.

>

> Cheryl

>

[Guest guest]

Synvisc should be covered under Medicare part B. It cost me $45.00 for the

medicine and $25.00 for the regular copay under my Aetna plan.

Under the commercial plan that I was on before Medicare, I paid $115.00 for the

drug and then my regular copay. My OR's staff said it is much easier to get

approval to inject the drug under Medicare rather than a regular plan.

Bev Oleksiak

Aurora, OH

> >

> > I appreciate everyone's response to my question about SynVisc. I like the

idea of trying SynVisc One, and will look into that. I have scheduled my

surgery for October, so I have some time to try the injections, and maybe delay

surgery.

> >

> > Cheryl

> >

>

[Guest guest]

Well she was told it would cost her $800.00 cash price for the injectable

medication because her Medicare Part D provider stated that the synvisc one was

not covered and then she asked if the other synvisc was maybe covered and I

think even that was not covered. And so she called her provider and it was

true.

LEANN

> > >

> > > I appreciate everyone's response to my question about SynVisc. I like the

idea of trying SynVisc One, and will look into that. I have scheduled my

surgery for October, so I have some time to try the injections, and maybe delay

surgery.

> > >

> > > Cheryl

> > >

> >

>

[Guest guest]

I talked to her last night and she has not had it done. She DID say that it was

a direct Medicare item denial beyond part D. She said her national pharmacy has

a national special center for specialty

meds which this one was a part of and which do not go through part D.

The only way she could get that injectable medication if she decides to self

pay is to agree to have that national headquarters ship/deliver it directly to

the office of the ortho docs who will be doing her knee injection.

So now we are hearing two Medicare coverage conflicting stories. This would not

be right for her to have to pay when others do or did not. I will have to get to

the bottom of this on her behalf.

(frown: as long as I have to sit around so much these days).

Maybe if she had medicaid as secondary her medicaid might have covered it. But

all she has is a medigap/supplemental which only covers the medicare deductibles

and copays etc.

LEANN

> >> > >

> >> > > I appreciate everyone's response to my question about SynVisc. I

> >> > > like the idea of trying SynVisc One, and will look into that. I have

> >> > > scheduled my surgery for October, so I have some time to try the

> >> > > injections, and maybe delay surgery.

> >> > >

> >> > > Cheryl

> >> > >

> >> >

> >>

> >

> >

> >

> >

> > ------------------------------------

> >

> >

[Guest guest]

Betsy, (my first reply to you did not show up for some reason so here is another

similar one)

You are correct in that it is not something paid for by Part D. I talked to my

friend again about this and she said her pharmacist had her call their chain's

national center (an 800 number) which deals directly with Medicare and handles

all the filling of special requests such as chemo etc. And they were the ones

who told her that they would be happy to fill her RX and deliver the injectable

Synvisc One medication to her docs office (delivery to the doc is a requirement

they told her) but that all of their attempts to get Medicare to pay for it were

rejected.

Now I am wondering what is going on. I think she said she even asked about the

mutiple injectable and was told " no dice " about Medicare paying for that as

well.

So now I don't like what I am hearing (reading) and I will now have to tell her

about your husband getting his paid for by

Medicare. Very Interesting. Thanks. And she was not working with a small

chain pharmacy headquarters. It was a large well known one en who should know

or should have known how to read " codes " or know when a payment is rejected.

LEANN

> >> > >

> >> > > I appreciate everyone's response to my question about SynVisc. I

> >> > > like the idea of trying SynVisc One, and will look into that. I have

> >> > > scheduled my surgery for October, so I have some time to try the

> >> > > injections, and maybe delay surgery.

> >> > >

> >> > > Cheryl

> >> > >

> >> >

> >>

> >

> >

> >

> >

> > ------------------------------------

> >

> >

[Guest guest]

Could it be that Medicare now requires that doc's give their patient the option

to decide what company they give their business to. I don't know anymore than

that she ended up with her local pharmacy referring her to their corporate or

national chemo division because they knew they could not get involved with or

dispense that type or class of medication.

LEANN

[Guest guest]

Same respect back to you but I assumed that you read my post which stated that

the friend was told by that national provider on the phone that the only way the

medication could be handled once paid for by her was to have it shipped by them

DIRECTLY to her the orthopedic docs office. Which is where she would have to go

to get that Dr.

to inject it into her knee.

So does that make you more comfortable. But it still does not explain why hers

was not going to get paid for by Medicare and another persons was.

I DID find an article showing how what the doc answers on some questionaire

and/or when asked about medical necessity can affect whether Medicare will pay

or not. So her doc might not have been a very stong advocate if that was the

case in her case.

Take care, I hope this post makes you feel better about the confusion.

LEANN

>

> > Could it be that Medicare now requires that doc's give their patient

> > the option to decide what company they give their business to. I

> > don't know anymore than that she ended up with her local pharmacy

> > referring her to their corporate or national chemo division because

> > they knew they could not get involved with or dispense that type or

> > class of medication.

> > LEANN

> >

> >

> >

>

>

>

>

[Guest guest]

Good luck.  It didn't work for me, my knees are just to far gone!!!! 

From: cecote@... <cecote@...>

Subject: SynVisc - THANK YOU ALL

Joint Replacement

Date: Sunday, May 9, 2010, 10:14 AM

 

I appreciate everyone's response to my question about SynVisc. I like the idea

of trying SynVisc One, and will look into that. I have scheduled my surgery for

October, so I have some time to try the injections, and maybe delay surgery.

Cheryl