Guest guest Posted June 30, 2011 Report Share Posted June 30, 2011 I am trying to help a patient obtain Valcyte post-kidney transplant. I applied for the patient from the manufacture (Genentech) and she was denied by Genentech that " she does not meet all the eligibility criteria and cannot provide assistance " . Genentech said if I can get a denial from an independent non-profit organization (i.e. Healthwell foundation, Patient Access Network) they will help the patient. Her Valcyte co-payments with her Medicare part D plan is $1,400.00 for 3 months. She cannot afford this. Healthwell foundation cannot help because they are currently not helping patients with diagnosis of CMV. Patient Access Network Foundation cannot help because she is receiving a pension/social security and has to have monthly copayments of $600.00 or more to be eligible. Any suggestions to help this patient? Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 30, 2011 Report Share Posted June 30, 2011 Robin- You can apply for Healthwell foundation using the kidney transplant as the diagnosis. Donovan Transplant Financial Coordinator SUNY Upstate Medical University 750 East Street Syracuse, New York 13210 Phone: 315 464-6290 Fax: 315 464-6288 Donovanl@... The information contained in this email is confidential intended only for the use of the party to whom it is addressed. If you are not the intended recipient, please be aware that you are strictly prohibited from sharing, distributing, or copying this email. If you have received this email by mistake, please notify the sender. Thank you. >>> " Robin " 6/30/2011 4:00 PM >>> I am trying to help a patient obtain Valcyte post-kidney transplant. I applied for the patient from the manufacture (Genentech) and she was denied by Genentech that " she does not meet all the eligibility criteria and cannot provide assistance " . Genentech said if I can get a denial from an independent non-profit organization (i.e. Healthwell foundation, Patient Access Network) they will help the patient. Her Valcyte co-payments with her Medicare part D plan is $1,400.00 for 3 months. She cannot afford this. Healthwell foundation cannot help because they are currently not helping patients with diagnosis of CMV. Patient Access Network Foundation cannot help because she is receiving a pension/social security and has to have monthly copayments of $600.00 or more to be eligible. Any suggestions to help this patient? Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 30, 2011 Report Share Posted June 30, 2011 What made it so she didn't meet the requirements with Genentech?? Was her income too high? Either way do you have a representative that comes to our office at all? In those situations that's when I contact them and tell them the scenario. Usually we come up with some sort of answer. Even if we don't at least he can voice these types of concerns when they discuss their financial assistance program. >>> "Robin" 6/30/2011 4:00 PM >>> I am trying to help a patient obtain Valcyte post-kidney transplant. I applied for the patient from the manufacture (Genentech) and she was denied by Genentech that "she does not meet all the eligibility criteria and cannot provide assistance". Genentech said if I can get a denial from an independent non-profit organization (i.e. Healthwell foundation, Patient Access Network) they will help the patient. Her Valcyte co-payments with her Medicare part D plan is $1,400.00 for 3 months. She cannot afford this. Healthwell foundation cannot help because they are currently not helping patients with diagnosis of CMV. Patient Access Network Foundation cannot help because she is receiving a pension/social security and has to have monthly copayments of $600.00 or more to be eligible.Any suggestions to help this patient? Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 30, 2011 Report Share Posted June 30, 2011 Patient Access Network website says they are accepting CMV applications - need to use the CMV diagnosis for either Healthwell or PAN. Also - has she applied for Prescription Advantage (a Massachusetts resource) or talked with Mass Medline (another Massachusetts resource)? Ms. Daryl Battin, LICSW Department of Transplantation -- Kidney Program Financial Coordinator/Social Worker Lahey Clinic 41 Mall Road Burlington, MA 01805 Phone: / FAX: Page: ________________________________ From: TxFinancialCoordinators on behalf of Robin Sent: Thu 6/30/2011 4:10 PM To: TxFinancialCoordinators Subject: Re: Valcyte Assistance I did. But Healthwell said they are currently not helping patients who need Valcyte and to check back in 3-4 weeks. > > Robin- > You can apply for Healthwell foundation using the kidney transplant as the > diagnosis. > > > Donovan > Transplant Financial Coordinator > SUNY Upstate Medical University > 750 East Street > Syracuse, New York 13210 > Phone: 315 464-6290 > Fax: 315 464-6288 > Donovanl@... > > The information contained in this email is confidential intended only for > the use of the party to whom it is addressed. If you are not the intended > recipient, please be aware that you are strictly prohibited from sharing, > distributing, or copying this email. If you have received this email by > mistake, please notify the sender. Thank you. > > > > > >>> " Robin " 6/30/2011 4:00 PM >>> > I am trying to help a patient obtain Valcyte post-kidney transplant. I > applied for the patient from the manufacture (Genentech) and she was denied > by Genentech that " she does not meet all the eligibility criteria and cannot > provide assistance " . Genentech said if I can get a denial from an > independent non-profit organization (i.e. Healthwell foundation, Patient > Access Network) they will help the patient. > > Her Valcyte co-payments with her Medicare part D plan is $1,400.00 for 3 > months. She cannot afford this. > > Healthwell foundation cannot help because they are currently not helping > patients with diagnosis of CMV. Patient Access Network Foundation cannot > help because she is receiving a pension/social security and has to have > monthly copayments of $600.00 or more to be eligible. > > Any suggestions to help this patient? > See our web page at http://www.lahey.org for a full directory of Lahey sites, staff, services and career opportunities. THIS MESSAGE IS INTENDED FOR THE USE OF THE PERSON TO WHOM IT IS ADDRESSED. IT MAY CONTAIN INFORMATION THAT IS PRIVILEGED, CONFIDENTIAL AND EXEMPT FROM DISCLOSURE UNDER APPLICABLE LAW. If you are not the intended recipient, your use of this message for any purpose is strictly prohibited. If you have received this communication in error, please delete the message and notify the sender so that we may correct our records. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 30, 2011 Report Share Posted June 30, 2011 these are both " denials " from the other assistance programs. go back to Genetech and tell them, they will approve your patient. >>> " Robin " 6/30/2011 3:00 PM >>> I am trying to help a patient obtain Valcyte post-kidney transplant. I applied for the patient from the manufacture (Genentech) and she was denied by Genentech that " she does not meet all the eligibility criteria and cannot provide assistance " . Genentech said if I can get a denial from an independent non-profit organization (i.e. Healthwell foundation, Patient Access Network) they will help the patient. Her Valcyte co-payments with her Medicare part D plan is $1,400.00 for 3 months. She cannot afford this. Healthwell foundation cannot help because they are currently not helping patients with diagnosis of CMV. Patient Access Network Foundation cannot help because she is receiving a pension/social security and has to have monthly copayments of $600.00 or more to be eligible. Any suggestions to help this patient? Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 30, 2011 Report Share Posted June 30, 2011 When you say Healthwell is not currently helping pts with CMV, does it mean that their program is closed at this time? (I just checked their website, but it is currently “under construction.â€) If so, that is technically the denial that you need to send to Genentech, in order for them to assist the patient. Please feel free to e-mail me directly and I can help with walking you through what paperwork is needed for Genentech! Is your patient in the donut hole at this time, by any chance? I just worked through a case like this and I was able to get the patient’s Valcyte covered at 100% for the remainder of his treatment! M. Christiansen, BAS, RNTransplant Financial Case Manager DeVos Heart and Lung Transplant Program100 Michigan NEMC 231Grand Rapids, MI 49503Phone: Pager: Fax: lisa.christiansen@... From: TxFinancialCoordinators [mailto:TxFinancialCoordinators ] On Behalf Of Jodi Macfarland Sent: Thursday, June 30, 2011 4:04 PMTo: TxFinancialCoordinators Subject: Re: Valcyte Assistance What made it so she didn't meet the requirements with Genentech?? Was her income too high? Either way do you have a representative that comes to our office at all? In those situations that's when I contact them and tell them the scenario. Usually we come up with some sort of answer. Even if we don't at least he can voice these types of concerns when they discuss their financial assistance program. >>> " Robin " 6/30/2011 4:00 PM >>> I am trying to help a patient obtain Valcyte post-kidney transplant. I applied for the patient from the manufacture (Genentech) and she was denied by Genentech that " she does not meet all the eligibility criteria and cannot provide assistance " . Genentech said if I can get a denial from an independent non-profit organization (i.e. Healthwell foundation, Patient Access Network) they will help the patient. Her Valcyte co-payments with her Medicare part D plan is $1,400.00 for 3 months. She cannot afford this. Healthwell foundation cannot help because they are currently not helping patients with diagnosis of CMV. Patient Access Network Foundation cannot help because she is receiving a pension/social security and has to have monthly copayments of $600.00 or more to be eligible.Any suggestions to help this patient? Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 1, 2011 Report Share Posted July 1, 2011 Thanks everybody for your help! I have faxed the copay assistance denial form to Genentech so hopefully this will ensure the patient gets her Valcyte! > > When you say Healthwell is not currently helping pts with CMV, does it mean that their program is closed at this time? (I just checked their website, but it is currently “under construction.â€) If so, that is technically the denial that you need to send to Genentech, in order for them to assist the patient. Please feel free to e-mail me directly and I can help with walking you through what paperwork is needed for Genentech! Is your patient in the donut hole at this time, by any chance? I just worked through a case like this and I was able to get the patient’s Valcyte covered at 100% for the remainder of his treatment! > > M. Christiansen, BAS, RN > Transplant Financial Case Manager > DeVos Heart and Lung Transplant Program > 100 Michigan NE > MC 231 > Grand Rapids, MI 49503 > Phone: Pager: Fax: > lisa.christiansen@... > > > From: TxFinancialCoordinators [mailto:TxFinancialCoordinators ] On Behalf Of Jodi Macfarland > Sent: Thursday, June 30, 2011 4:04 PM > To: TxFinancialCoordinators > Subject: Re: Valcyte Assistance > > What made it so she didn't meet the requirements with Genentech?? Was her income too high? > > Either way do you have a representative that comes to our office at all? In those situations that's when I contact them and tell them the scenario. Usually we come up with some sort of answer. Even if we don't at least he can voice these types of concerns when they discuss their financial assistance program. > > >>> " Robin " 6/30/2011 4:00 PM >>> > > > I am trying to help a patient obtain Valcyte post-kidney transplant. I applied for the patient from the manufacture (Genentech) and she was denied by Genentech that " she does not meet all the eligibility criteria and cannot provide assistance " . Genentech said if I can get a denial from an independent non-profit organization (i.e. Healthwell foundation, Patient Access Network) they will help the patient. > > Her Valcyte co-payments with her Medicare part D plan is $1,400.00 for 3 months. She cannot afford this. > > Healthwell foundation cannot help because they are currently not helping patients with diagnosis of CMV. Patient Access Network Foundation cannot help because she is receiving a pension/social security and has to have monthly copayments of $600.00 or more to be eligible. > > Any suggestions to help this patient? > Quote Link to comment Share on other sites More sharing options...
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