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In this day and age, why is Egrifta not able to be administered using either an epipen type injection, a forced air delivery system or better yet, a skin patch? Seems like so many meds that involve delivery through the skin can eliminate the use of needles and the biohazards associated with them. Just curious.
My insurance company, Sharp Community Healthcare Plan are denying coverage. Any ideas on how to get them to pay for this prescription?? Any help or advice would be appreciated. Thank you,
Hello, My HMO, Healthnet has denied Egrifta because they say it is "cosmetic". Even the IMR agreed, However I see many comments that the drug has other benefits. How do I go back to my insurance company with a statement that others have found works? Any help would be appreciated.
I am amazed that Medicare pays for Egrifta, yet people not on disability can't get it without fighting their insurance carrier. Can anyone give me an update on this situation? It's December 2011. Is Egrifta being covered more by insurance? My carrier is paying for Serostim, yet I am afraid to switch to Egrifta, even though it appears to be a safer product.
But what good are these drugs if the majority of people cannot afford them and insurance says that won't pay for it??
Tim, thank you for covering and caring about this issue. I appreciate your work. I know lipdystrophy affects a relatively small number of people, but I'm one of those people. I care. I was thrilled when Egrifta (tesamorelin) was FDA approved. I see Egrifta as one important option in a armamentarium available to physicians and patients, like me. Unfortunately, here's what's happening post approval: private health insurers (e.g., Blue Cross/Blue Shield) are denying reimbursement on the basis that Egrifta is "cosmetic." In contrast, Medicare is paying for Egrifta. I'm sure EMD Serono wouldn't have pursued a distribution contract with Theratechnologies if Serono wasn't guaranteed coverage from Medicare. We already know Serono likes to push Serostim onto Medicare patients. It's easy money for Serono. Now, Serono distributes Egrifta in the U.S. Apparently, the Serono marketing push again is only for Medicare patients. Three years ago, I qualified for the phase III clinical trials. I know the benefits of Egrifta firsthand. Amazing, at least for me. But then, I'm a highly motivated patient who cares. Now, with FDA approval, my doctor prescribed Egrifta for me. I got one month's supply and then my health insurer denied to pay further. My doctor was clear, he did not want to deal with the hassles of securing reimbursement. He said, that's the job of Serono's Axis Center. Let's be clear, the Axis Center and Serono are the same. At first, when my insurance appeared to cover Egrifta, the Axis Center was awesome: follow-up phone calls, great service etc. But once my insurance denied to pay, the customer service stopped abruptly. Jessica at the Axis Center was great -- until reimbursement stopped. Now I can't even get one return phone call. My doctor doesn't want to deal with reimbursement issues. Axis/Serono doesn't return calls now that my private insurance denies coverage. And yet, all my unemployed Medicare friends are now getting Egrifta, no questions asked. As a hardworking taxpayer who cares about rising healthcare costs, do I want to pay taxes so other people can get Egrifta when I can't get it? Private healthcare deems Egrifta cosmetic, while public healthcare deems it medically necessary? Huh? I know many HIV-positive people depend on Medicare. Fine. But I also know that some HIV-positive Medicare patients work the system. HIV has created a suspicious class of "welfare queens." I suspect many on Medicare will take Egfita for a few months, stop taking it, and start reselling it the black market -- just as they did with Serostim. It's a scam and Serono knows it. Now, who truly deserves Egrifta? HIV-positive people care about rising healthcare costs, who deeply care about their own health, longevity, don't smoke cigarettes, eat healthy, and exercise all in a larger effort to reduce cardiovascular risk factors? Or, HIV-positive Medicare welfare queens who, simply by not working, who probably smoke, who probably eat junk, and probably have no conscious about collective healthcare costs, these queens now get access to Egrifta? I suspect in Serono's marketing world, the answer is: Get any and all Medicare patients on Egrifta and don't waste your time with people with private health insurance. Something's wrong with this picture. And I care. Brett Grodeck Twitter: @Brett_Grodeck
Just wanted to add that it is good to know that something is been done medically about lipodystropy. Though you mentioned that Egrifta would help with this problem it only mentions belly fat lipodistrophy reduction but makes no mention of the so called "elephant hump" lipodystropy problem which a lot of HIV+ people also experience. Since there is no mention of this problem in the article, does Egrifta help this condition or not. I would like to hear about any inforamtion on this issue in any available article on whether there is any hope for those of us who suffer from this particular condition.
Dr. Karron Power
As a doctor living and practicing in San Francisco, I am greatly disappointed in the number of insurance companies denying Egrifta coverage on the basis of its use being "cosmetic". We clearly understand the impact of excess visceral body fat on cardiovascular health. And mental health issues remain medical! That's why antidepressants and anxiolytics ARE covered by insurance companies. Lipodystrophy can cause mild distress to severe anguish in sufferers and should be treated. I can't change the insurance or the pharmaceutical industry, but I do offer my patients an option. Most people don't know that there is a generic option to Egrifta that is also bio-identical (that is, identical to the growth hormone releasing hormone normally produced in the human body). Serono made this bio-identical product first, but when they lost their patent, they changed it slightly and re-released it as the much more expensive "Egrifta". Luckily, the original drug can still be found! Treatment still isn't cheap, but it is much more affordable. Generally, treatment runs around $200-250 per month. Egrifta can cost several times that amount. Look into the alternatives and good luck to all of you! Warmly, Dr. Power, Youth Renewal Center
January 30, 2013