• Reata & Insurance

    Posted by Tina-D on June 9, 2023 at 3:45 pm

    Has anybody cleared the insurance hurdle yet?

    My insurance company told Reata since Skyclaris is an experimental drug they will not cover the$400,000.00/year cost. Reata said ok and that was it.

    Any tips on how to change Cigna’s mind?

    Tina-D replied 8 months, 4 weeks ago 4 Members · 7 Replies
  • 7 Replies
  • kevin-shannon

    Member
    June 13, 2023 at 4:16 pm

    Christina,

    Sorry to hear about your experience with Reata thus far. If this is what Cigna told you, I would be skeptical. Our neurologist told us in March that Skyclaris has not been released for prescriptions due to the negotiation period between Reata and the large insurance companies. He has 2 other FA patients he’s seeing. This process is where Reata figures out what the insurance companies are willing to pay vs what they will charge. Reata’s initially advertised price of approx $1,000 per day was just the opening price of the negotiations. I have not found any media updates on the negotiations thus far. If no one can afford Skyclaris, Reata will lower the price.
    Unfortunately, my son, Collin, is late-stage FA with severe cardiomyopathy who will not be able to take Skyclaris.

    Keep fighting with Cigna and Reata, and I hope this info helps you.

  • jonathan

    Member
    June 14, 2023 at 7:59 am

    I’m 42. GAA repeats measurements are about 650 and 900. I’ve got United Healthcare/Medicare. I just got the recorded message phone call from either Reata or its pharmacy (Biologique or something) that they got pre-authorization.

    Be sure to register with Reata’s REACH program. Their main purpose is to coordinate funding for the patient getting the drug.

    BTW the pharmacy isn’t expected to be ready for distribution of prescriptions until about mid-August.

     

     

  • jonathan

    Member
    June 14, 2023 at 9:58 am

    Actually, the pre-authorization came from my prescription insurance which is OptumRX. I think that’s a Medicare Part D thing.

  • jonathan

    Member
    June 16, 2023 at 5:25 am

    The pharmacy also called (yesterday afternoon) nd confirmed confirmed coverage. The pharmacist was very kind and went over the usual precautions and details for a new prescription.

    BTW, the pharmacy is called Biologics.

  • ray-cotton

    Member
    June 19, 2023 at 9:30 pm

    Hi, Christina; I am sorry you got that feedback from Cigna.  I also have Cigna, and I received an approval letter from them.  The difference, I think, is that my wife is the CHRO Chief Human Resources Officer for her company.  That means I asked her to call her insurance broker and add this to her company’s policy.  Is that unusual? Yes and no.  She has had people thru the years specifically ask for MS drugs to be covered by the company, and she has complied because the cost to the company is minuscule. My advice, sit down with your Human Resources department and ask them to add it to the policy, then ask the folks at Reata’s Reach program to rerun the process.  You’re also welcome to PM privately if you need additional guidance.

    Best,

    Ray

    • Tina-D

      Member
      June 20, 2023 at 2:49 pm

      I can’t believe Cigna can cover a drug for one person and not everyone! I’ll have my husband call HR.

    • Tina-D

      Member
      July 21, 2023 at 9:11 am

      No luck going through HR. Cigna told HR medication could only be added after my doctor answers their questions. He did. Cigna still said no.

  • katie

    Member
    July 26, 2023 at 3:12 pm

    make sure you connect with reata reach: https://www.reatareach.com/

    the copay may be waived for low income patients and they appear willing to lower them for others.

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