Insurance companies change what they cover yearly . it's all about profit even when they subsidized . Have your pharmacy find a part d plan that will cover cellcept or the generic for it . Good luck

Not sure what your options are. United Healthcare is really getting killed by Obamacare! Can you get another provider? Could be heading for a merger of some kind in order to save face or perhaps it will just shut down at some point. Maybe it will be controlled by the government on some pre-planned idea by the establishment. (conspiracy you say?) Wouldn't surprise me one bit!

http://ctmirror.org/2015/12/09/unitedhealthcare-to-stop-paying-commissions-for-obamacare-exchange-plans/

Good luck!

They called it "off label"
I find that interesting
Appears to be a twisted way to say too expensive for us to cover.
People thought Obama care would help.....I have only seen more problems and wait time for appointments, paper work for doctors, and more expensive co pays for me.

A quote from a research paper about cellcept (generic name) 2011

"Mycophenolate mofetil is regarded as an alternative drug for mild MG. However, after promising results in open MG patient treatment, randomized and controlled trials failed to confirm a positive effect. The drug has few and mild side effects and is easy to use both for patients and doctors. Despite its limitations, mycophenolate mofetil is still regarded as an alternative drug for mild MG, whereas more severe MG is usually not treated by this drug because of the negative controlled trials."

http://www.hindawi.com/journals/ad/2011/847393
'
The decision as to what drugs to cover made by a private health care company like United Health is based on their view of research and their financial decisions. Medicare and Obamacare are really not directly connected to the decisions of which drugs to cover for particular diseases. That is why some people on medicare with their supplemental drug insurance get cellcept or ivig coverage for MG and others don't--an insurance company decision.

Hope you can find a company or plan that covers you.
Good Luck

Costco http://www.costco.com/Pharmacy/drug-results-details-price?storeId=10301&catalogId=10701&langId=-1&searchKeyword=mycophenolate+mofetil&drugId=419&drugName=MYCOPHENOLATE&drugSearch=headerDrugSearch&isPharmacy=true&encodedDrugName=MYCOPHENOLATE

Generic Alternative:
MYCOPHENOLATE 500 MG TABLET

$22.49 30 tablets
$32.35 50
$55.37 100

You can try to contact the manufacturer, as well. Most drug companies have patient assistance programs for their medications based on your household income. If you don't qualify for those programs they can usually provide assistance through your doctor by providing them samples of the drug (If the doc actually keeps sample medication in their office.) The other option is to find out if your neuro can do a peer to peer review with the insurance company to get approval for the drug regardless of what they "Usually" cover and not cover. The purpose is to show that you've been successful in the use of this medication for several years and that removing that treatment option may likely cause them more money through alternative options. They usually have to provide evidence (usually via studies or medical journal articles) that supports the use of the drug and show how you've either been stabilized by the drug or improved. A lot of doctors don't take the time to go through that kind of a mess but those who do stick it out usually find success in their efforts.

Good luck to you and please let us know what you find out or end up doing.

I have a new Neurologist who prescribed Cellcept for me. They had to request pre-authorizaton from Amthem Blue Cross that has my Part D coverage because it was so expensive. They did approve it. It is an off brand use for MG since it's on brand use is for patients with transplants. It helps prevent the body from rejecting the transplanted organ. Switch to another Part D provider who does cover it if you can. Good Luck.

You post doesn't indicate whether you trying to fill Cellcept or its generic mycophenolate? Generally, brand name drugs will not be covered if there is a generic available. That being said, Medicare rules for Cellcept (mycophenolate) do indeed depend on what it is being used for. Cellcept is approved by the FDA for the prevention of tissue rejection in organ transplants. All other uses are considered off-label. However, that does not mean it can't be covered. Medicare requires plans to cover drugs that are prescribed for "medically accepted use" which means that even if it is off label and the drug's off-label use is listed in official reference compendia, the plan must cover the drug. This may require your prescriber to submit a request for a coverage determination for approving your claim.

Following. Also wondering if anyone has successfully appealed to their insurance company to get them to reverse their denial for coverage of Mycophenolate.

I just checked, and my generic cellcept cost me a $15 deductible, and the plan was billed $46.05. This is for 120 500 mg.

Interestingly, my generic mestinon cost me the $15 deductible, and the plan was billed $184.56 for 180 tabs.

The mestinon was from my local pharmacy Kinney Drugs, and they had transferred the cellcept script to their specialty pharmacy Noble Pharmaceuticals in Syracuse.

Don't know if this will help. The reference used for Medicare is based on https://www.ssa.gov/OP_Home/ssact/title19/1927.htm section 1927 of the Soc Sec Act. CMS in 2016 has taken action to deny mycophenolate (cellcept) except for FDA approved uses or those listed in "the compendium". Which CMS is taking from the SocSec act as: American Hospital Formulary Service Drug Information; and the DRUGDEX Information System. Note in the section I referenced in the SocSec act it lists 1 more and also says: the peer-reviewed medical literature. Legal rulings on this appears blurry. We are currently trying to appeal for another off book use (polymyositis) and CMS apparently ignores the last item in the .gov online version of the act: https://www.ssa.gov/OP_Home/ssact/title19/1927.htm. Perhaps there are other overriding references in the act or guidelines to CMS of which we are not aware.

I just got a ruling from an Administrative Law Judge stating that my Medicare Part D plan must cover mycophenolate for my MG. Apparently this off-label use was only recently added to the DRUGDEX compendium, making it an eligible drug.

Yes, Spike, The MGFA just came out with this press release about the CellCept approval: We have received word that Cellcept (mycophenolate mofetil) has been approved for use in MG in one of the drug compendia used by CMS and many insurance companies. We heard from a patient who received this letter reversing a previous denial for payment.
"We've changed our decision on your appeal. We re-opened and approved your appeal based on new information. When we reviewed your appeal before, the Medicare-approved references didn't support using this medicine for myasthenia gravis (MG). But, there was a recent update to DrugDex (a Medicare-approved resource). DrugDex now supports mycophenolate for MG. So, we're now able to cover it."
This update to DrugDex is a direct result of appeals from MG clinicians: Ted Burns. MD (UVA), who put together a compelling package of evidence of the efficacy of Cellcept in MG and badgered the company regularly to get attention--- and also George Small, MD and Michelle Dulashaw (Allegheny Health). Dr. Burns states that he is certain that the new treatment guidelines, International Consensus Guidance for the Management of Myasthenis Gravis, funded by MGFA and led by Drs. Don Sanders, Gil Wolfe, and Pushpa Naryanaswami, were integral to this change---and so he and MGFA want to thank all involved in that effort. Here is a link to this landmark paper published in Neurology:
http://www.neurology.org/content/early/2016/06/29/WNL.0000000000002790.short
We urge all patients who have received denials for mycophenolate to appeal the denial based on this update.