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Thread: 4-AP pharmacies that accept insurance

  1. #1

    4-AP pharmacies that accept insurance

    My Dad is now on Ampyra 10mg twice a day, but since his insurance has not yet approved the dose he needs (20mg twice a day), we supplement with the short acting 4-AP.

    We just found out his compounding pharmacy (College Pharmacy) wont take our Blue Cross insurance anymore. So we are looking for a new compounding pharmacy that makes 4-AP and the ideal will be one that takes insurance. We have found a couple compounded pharmacies (ex. The Compounder in Illinois), but they wont work with insurance.

    Thanks.

    Also curious if anyone has gotten their insurance companies to cover more then 10mg twice a day of Ampyra?

  2. #2
    bump.

  3. #3
    My understanding is that the compounded 4-AP is no longer approved for use.
    Every day I wake up is a good one

  4. #4
    Super Moderator Sue Pendleton's Avatar
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    Quote Originally Posted by cheesecake View Post
    My understanding is that the compounded 4-AP is no longer approved for use.
    Same here although some local compounding places have not gotten the word near us Cheese. HLH try locally because I think the FDA basically targetted the ones that advertise 4-AP nationally for follow up letters.

    And for my use, does his insurance cover Ampyra for incomplete SCI or is his for MS?
    Courage doesn't always roar. Sometimes courage is the quiet voice at the end of the day saying, "I will try again tomorrow."

    Disclaimer: Answers, suggestions, and/or comments do not constitute medical advice expressed or implied and are based solely on my experiences as a SCI patient. Please consult your attending physician for medical advise and treatment. In the event of a medical emergency please call 911.

  5. #5
    Thanks for your replies.

    Actually, pharmacies are still allowed to compound the short acting formulation of 4-AP. Since Ampyra has the patent for the long-acting formulation, only that one is off limits for the compounders.

    I did finally find a pharmacy that takes our insurance, seems nice, and will make the short acting 4-AP.

    http://www.chancydrugs.com/

    I'm going to mail them a script next month.

    But yes, we have had success with getting Blue Cross Blue Shield of Illinois (Primemail) to pay for Ampyra for incomplete spinal cord injury. They had a pre-approval form that we had to fill out with his doc. The form was clearly written for patients with MS, but there were a few "other" boxes that we checked, and added as many relevant details as we could. We also sent a detailed letter explaining his 3 year use of 4-AP with good results.

    The form also asked for a "timed" 15 foot walk, I think... So one of the days he was at rehab, we did a formal "timed" 15 foot walk - one from seated position, one from standing. I have heard a rumor that some MS patients get declined if their walking speed isn't "fast enough" initially, but I don't know if that is true.

    So they sent us Ampyra 10mg twice a day, because that is the standard dose they approved for MS. But he needs double that dose to be equivalent to his prior long acting 4-AP dose of 20mg twice a day. They denied that initially, and we just sent a very strong appeal letter. Should hear back in another week or so.

    In my mind, how can they previously pay for 4-AP long acting 20mg twice a day, and not pay for the equivalent dose of Ampyra? If that agreed that the 4-AP dose was medically necessary, then the Ampyra dose is too.

    We'll see.... I give it 50/50.

  6. #6
    Just an update.

    We have been getting our compounded short-acting 4-AP from Chancy Drugs for the past couple months. They are inexpensive...... relatively. Less the $50 for 100 capsules of 10mg. That is actually less then our co-pay for compounded drugs, so we pay for all of it out-of-pocket. They mail it to us monthly.

    But even better news.... we just found out from our insurance BCBS that my father will be approved for the higher dose of AMPYRA 20mg twice a day. He is an incomplete SCI and to our knowledge, this is the only time we have heard of someone getting approval for a higher dose then was used in the clinical trials for MS.... for spinal cord injury.

    It is my understanding that the concern of higher doses of 4-AP and Ampyra is the possible side effect of seizure, although this is infrequent. However, I suspect this side effect is more concerning for patients with MS who may have brain plaques (demyelination) that for the typical SCI patient. I thought the insurance company might use that "risk" as a reason for denying us a higher dose of Ampyra, but they did not.

    So don't be afraid to fight with your insurance company for Ampyra. Doctors are allowed to use it "off label" for SCI, and they do not have to limit the dose to what was used in the clinical trial for MS. Appeal their rejection.

    This is a really inappropriate forum for this thread, so I will post this update in another Ampyra thread.

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