Interaction Review

Hello, Margaret. This is Emily Rodriguez from the Neurexil Patient Support Program. How are you doing today?

Hi Emily. I'm okay, thank you. My daughter Karen is actually here with me on speaker phone. She helps me manage my medications.

Hi Karen, nice to meet you. Margaret, let me pull up your case file. I see that your neurologist, Dr. Peters, submitted a prescription for Neurexil 0.5mg for your relapsing MS. Is that correct?

Yes, that's right. We tried Neurexil because the interferon injections were causing terrible flu-like symptoms. But my insurance denied the prior authorization.

I'm sorry to hear about the denial. Let me look at the details. It appears your plan requires a step-through of another oral disease-modifying therapy before covering Neurexil. Have you tried any other oral MS medications previously?

No, I went straight from the injectables to asking about Neurexil because my friend takes it and has had great results.

Is there any way around the step therapy requirement? Mom has been really struggling, and Dr. Peters specifically recommended Neurexil because of her liver enzyme levels.

I understand the urgency. There are a few paths we can explore. First, Dr. Peters can submit a medical exception request documenting why Neurexil is specifically appropriate for your mother. The elevated liver enzymes could be a valid clinical reason since some other oral therapies carry hepatotoxicity warnings.

Second, we have our Neurexil Bridge Program that can provide up to 90 days of medication at no cost while the appeal is being processed. I can get Margaret enrolled in that today.

Oh, that would be wonderful! I was worried I'd have to wait months without any treatment.

We definitely don't want any gaps in your treatment. Let me walk you through the bridge enrollment. I'll need to verify some information. Margaret, can you confirm your date of birth and the last four digits of your Social Security number?

Sure, it's April 15, 1958, and the last four are 7824.

Thank you, Margaret. I've started the bridge enrollment. You should receive your first shipment within five to seven business days. I'll also send a letter of medical necessity template to Dr. Peters' office to support the appeal.

Thank you, Emily. What happens if the appeal is also denied?

If the appeal is denied, we have our Patient Assistance Foundation which provides Neurexil at no cost for eligible patients based on income. Margaret, based on the information we have, you would likely qualify. I'll send you that application as well so we have a backup plan in place.