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Posted: Thu Aug 5th, 2004 10:08 |
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Letters of Medical Necessity
Sometimes an insurance company will balk at covering the higher-than-usual dosage of Benicar. You may have to accept the standard amount of pills until the insurance company approves the increased dosage.
You can start taking Benicar at the prescribed dose right away and hope that your appeal will be successful in a short time frame, or wait until you have the full prescription filled. If you run out of Benicar before being able to fill the remainder of the prescription, it is safe to stop Benicar abruptly and start it again when the full prescription is approved.
An appeal for benefits usually takes a couple weeks. Call your insurance company and explain the situation to find out their coverage and the procedure to follow if you need to apply for an exception. Get a fax or phone number for your doctor’s convenience.
Your doctor may be required to write a 'Letter of Medical Necessity'. Below are form letters for CFS, Lyme, and Sarcoidosis that your doctor may find convenient to use. It contains the information that has helped some Marshall Protocol patients get their full medication insurance benefit.
Letter of Medical Necessity for CFS
To Whom It May Concern:
"..... is my patient and is currently under my care for Chronic Fatigue/Immune Deficiency Syndrome/Myalgic Encephalitis. I have prescribed Benicar, an Angiotensin II Receptor Blocker, at 40mg every six hours.
Patients with this condition have a dysregulated Vitamin D metabolism which causes abnormally high levels of the active metabolite 1,25-dihydroxyvitamin-D. This results in chronic inflammation which prevents the immune system from attacking the pleomorphic pathogens that trigger this hypervitaminosis-D.
By blocking the angiotensin receptor sites, Benicar reduces the level of 1,25-D dramatically and provides an inflammatory blockade which allows the immune system to function normally. This also potentiates the use of low dose antibiotics to eliminate the cell wall deficient bacteria that are the underlying cause of this disease process.
Patients with inflammatory disease have many additional angiotensin II receptors in their inflamed tissues and they all need to be blocked to provide an adequate anti-inflammatory effect.
This inflammatory blockade only works if an adequate blood level of Benicar is maintained by dosing every six to eight hours. Therefore the dosage has to be individualized (in full accordance with the labeling) in order for the drug to achieve this effect.
FDA guidelines allow this dosing and this medication does not work effectively for this purpose at a lower dosage.
No other ARB (angiotensin receptor blocker) is adequate to substitute for Benicar(olmesartan), as Olmesartan alone performs the specific actions needed to also act upon the VDR(vitamin D receptor) and fully enable the immune system.
Thank you for your consideration in this matter.
Sincerely,
.....................................................................................
Letter of Medical Necessity for Lyme Disease
To Whom It May Concern:
"..... is my patient and is currently under my care for chronic Lyme disease. I have prescribed Benicar, an Angiotensin II Receptor Blocker, at 40mg every six hours.
Chronic Lyme patients have a dysregulated Vitamin D metabolism which causes abnormally high levels of the active metabolite 1,25-dihydroxyvitamin-D. This results in chronic inflammation and prevents the immune system from killing the Lyme spirochete even with long-term use of antibiotics.
By blocking the angiotensin receptor sites, Benicar reduces the level of 1,25-D dramatically and provides an inflammatory blockade which allows the immune system to function normally. This greatly potentiates the use of antibiotics.
Patients with inflammatory disease have many additional angiotensin II receptors in their inflamed tissues and they all need to be blocked to provide an adequate anti-inflammatory effect.
This inflammatory blockade only works if an adequate blood level of Benicar is maintained by dosing at least every six to eight hours. Therefore the dosage has to be individualized (in full accordance with the labeling) in order for the drug to achieve this effect.
FDA guidelines allow this dosing and this medication does not work effectively for this purpose at a lower dosage.
No other ARB (angiotensin receptor blocker) is adequate to substitute for Benicar(olmesartan), as it alone performs the specific actions needed to also act upon the VDR (vitamin D receptor) and fully enable the immune system.
Thank you for your consideration in this matter.
Sincerely,
......................................................................................
Letter of Medical Necessity for Sarcoidosis
To Whom It May Concern:
"..... is my patient and is currently under my care for sarcoidosis. I have prescribed Benicar, an Angiotensin II Receptor Blocker, at 40mg every six hours.
Sarcoidosis patients have a dysregulated Vitamin D metabolism which causes abnormally high levels of the active metabolite 1,25-dihydroxyvitamin-D. This results in chronic inflammation and prevents the immune system from killing the cell-dwelling pathogens that trigger the abnormal immune response.
By blocking the angiotensin receptor sites, Benicar reduces the level of 1,25-D dramatically and provides an inflammatory blockade which allows the immune system to function normally. This greatly potentiates the use of antibiotics that treat the underlying cause of the disease.
Studies have shown that sarcoidosis patients have additional Angiotensin II receptors in their inflammatory granuloma and they all need to be blocked to provide an adequate anti-inflammatory effect.
This inflammatory blockade only works if an adequate blood level of Benicar is maintained by dosing every six to eight hours. Therefore, the Benicar dosage has to be individualized (in full accordance with the labeling) in order for the drug to be fully effective.
FDA guidelines allow this dosing and this medication does not work effectively for this purpose at a lower dosage, due to the sarcoid inflammation.
No other ARB (angiotensin receptor blocker) is adequate to substitute for Benicar(olmesartan), as it alone performs the specific actions needed to also act upon the VDR (vitamin D receptor) and fully enable the immune system.
Thank you for your consideration in this matter.
Sincerely,
.......................................................................................
A diagnosis of hypertension is helpful
If the pt fits the criteria for diagnosis of hypertension, the FDA approved indication, and if pt's BP doesn't respond adequately to one 40mg tablet a day, then the prescribing instructions' "Dosage and Administration" saying "dosage must be individualized" can save a lot of hassle.
The package insert/prescribing instructions are available from the FDA website here.
____________________
*We can help you understand chronic disease, but only your physician is licensed to give you medical care *
Always consult your physician before commencing or changing any treatment he/she has prescribed for you
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Posted: Wed Feb 2nd, 2005 22:07 |
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Consent to Treatment form
---redacted Dec 2008 --
This document is no longer useful (several Docs have called to ask what it is all about). At this point the best way to get a physician on board is to give them copies of the Scientific papers and Conference transcripts 
Last edited on Fri Dec 19th, 2008 02:57 by Dr Trevor Marshall
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Posted: Wed Feb 2nd, 2005 22:36 |
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Letter to insurance company
Here is my letter to the Insurance Company that worked for me . . . NOTE TO MP.COM - - - I HAVE EXCLUDED ALL PRIVATE INFORMATION . . .
Best of Luck!
Rick in Napa (napamac)
___________________
* This Letter may have your antibiotics added also if applicable to your policy:
TO: _ _ _ _ Insurance Company
Pharmacy Prior Authorization Department
From: Rick _ _ _ _ _ _ _
Re: Benicar Rx for Treatment of Sarcoidosis and request for
40mg #120 per month
*Antibiotic: if applicable. as Rx by Dr.
I have been under direct supervision of Dr. _ _ _ _ _ _, M.D., F.C.C.P., for the continued treatment of Lung Sarcoidosis since 3/03, utilizing the Marshall Protocol as described at the marshallprotocol.com site listed below. This request for an increase in the number of tabs from 90 per month to 120 per month is to cover those days when the immunopathology is not being relieved with the normal Benicar dosage.
While following the protocol, I have progressed from total lethargy, mild depression, extreme fatigue and continuous daily coughing to . . .
Being able to return to work and most other activities with little to no problems as described above. And as long as I stay out of the sun and avoid Vitamin D in my foods, I feel like an almost cured person.
The Marshall Protocol is working for me, as well as others, without the use of steroids. Without it, I would return to the aforementioned problems and not be able to function nor provide for my family.
It is my hope that you will take the time to visit http://www.marshallprotocol.info, read the materials for physicians and understand the significance of the Marshall Protocol. Dr. Trevor Marshall (805 492-3693 or Trevor.m@y.. ) is also willing to discuss and/or clarify any part of the protocol with you.
Your assistance with my request, which is supported by my pulmonary physician would be greatly appreciated.
Sincerely,
Richard _ _ _ _ _ _
________________________________________
All supportive research and available papers can be located at:
PAPERS FOR PHYSICIANS
Dr. Marshall's scientific papers and presentations
BENICAR
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Posted: Fri Feb 18th, 2005 07:41 |
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How can I find out if my pharmacy benefits (insurance coverage for prescription drugs) will cover my prescription?
The first step in shopping for prescription drug prices is to find out whether a drug is covered by your insurance policy. If so, even before you've met your deductible, you may be entitled to discounted prices that your insurer has negotiated with pharmacies.
If a particular insurance plan covers a drug, you should pay the insurer's discounted rate at any pharmacy in that insurer's network. That price will likely beat the retail price without insurance, but you may want to check to be sure. Go to your employer's or insurance carrier's website and search for information about how to find out what drugs are covered. There may be a calculator to find out how much you would have to pay for a drug, depending on where it is filled.
Under many pharmacy benefit plans, there are different levels of coverage. The first tier of coverage usually includes generic drugs. The second tier may be a select group of drugs called a "formulary list" that the insurance company offers at preferred coverage because they have negotiated prices. The third tier of coverage is brand-name drugs not on the preferred list. The customer's co-payment amounts will vary, depending upon the category a drug is listed in.
Mail-order pharmacy coverage is becoming more common. Some plans even require that drugs taken regularly, called "maintenance drugs" must be ordered through their mail order pharmacy. Most plans will allow you to try a new medication at a local pharmacy first, to see if it will suit your needs. If the first prescription works as expected, you can submit the doctor's long-term prescription to the mail order pharmacy. Plan on at least two weeks to process a mail order. Because of this lead time, some patients ask their physician to write two prescriptions: one for the local pharmacy and a longer-term order (usually 3 months) for mail order.
Some mail order pharmacies may have online sites that allow you to order and track prescription refills. You may be able to sign up for email notices to be sent to you when your order is received and when it is placed in the mail.Last edited on Tue Feb 22nd, 2005 15:29 by Foundation Staff.
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Posted: Fri Feb 18th, 2005 07:57 |
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What if my plan doesn't cover my prescription?
Insurers do have an appeals process if they don't cover a drug that a doctor is convinced is best for a patient. Look in your benefits coverage information to find out the appeals process for your plan. Otherwise, you can simply accept the lower level of coverage.
If a prescription's coverage is denied through an administrative decision, look through the other information in this topic. See if you took all the steps to allow for a favorable decision. A letter of medical necessity or a phone call from the doctor may be all it takes to turn around an initially negative review.
If you should be told that your pharmacy benefits do not cover the Marshall Protocol, stay focused on the fact that your doctor ordered a specific drug from the pharmacy, not "the Marshall Protocol." You and will need to discuss and/or appeal the specific prescription, why it is medically necessary and what medical problem you are being treated for. Make sure your individual prescription is considered on this basis. You will probably need some assistance from your doctor.
If you find you will have to pay the list price for a drug, make some quick price checks before you buy. DestinationRx lists prices from a number of websites. The websites of individual stores, such as drugstore.com and Walgreens will have prices online. You will need to call the warehouse clubs like Sam's and Costco. In some states, these pharmacies must be open to the general public even if they do not have a warehouse club membership.
Ultimately you may have to call several pharmacies, including brick and mortar ones. Prices will likely vary from pharmacy to pharmacy. Try some large chains, as well as local independent pharmacies. You may find independent drugstores may have a reasonable price for a particular drug.
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Posted: Fri Feb 18th, 2005 07:59 |
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Is there an easy way to get my prescription refilled?
When it is time for refills, some pharmacies have automated or online order systems that are great time savers. You will need to have your prescription bottle on hand to answer all the questions.
Many doctors' offices prefer that patients call the pharmacy to ask for a refill, even if no refills remain on the prescription, instead of first contacting their office. The pharmacy will then fax the doctor's office asking if the doctor will authorize or deny a refill. This method can save steps in the authorization process and provides written documentation for refills. Last edited on Fri Feb 18th, 2005 08:00 by Foundation Staff.
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Aussie Barb
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Posted: Thu Jul 21st, 2005 09:35 |
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(filelink)
Off-label use of Benicar
In the United States, once a drug is approved for sale for a particular purpose, a physician can prescribe it for any clinical condition.
Last edited on Thu Aug 2nd, 2007 23:38 by
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Barb: Dx Inflammatory Disease Endocrine Imbalance 2003| Depression| 24+ years not Dx| MP Aug04| ABC of MP| MP Search|
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Aussie Barb
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Posted: Sat Jul 23rd, 2005 05:12 |
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(filelink)
See this letter to MEDCO: by Rick
____________________
Barb: Dx Inflammatory Disease Endocrine Imbalance 2003| Depression| 24+ years not Dx| MP Aug04| ABC of MP| MP Search|
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Aussie Barb
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Posted: Tue Aug 2nd, 2005 00:29 |
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(filelink)
Mail order
Those who have medication insurance can save a few more $$ by using the mail-order option instead of buying by the month from a local pharmacy. You may wish to use the mail-order for meds taken long-term and the local pharmacy for short-term meds.
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Barb: Dx Inflammatory Disease Endocrine Imbalance 2003| Depression| 24+ years not Dx| MP Aug04| ABC of MP| MP Search|
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Aussie Barb
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Posted: Wed Aug 24th, 2005 23:02 |
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Appealing the insurance company's decision
(filelink)
Q: My insurance company has denied coverage for Benicar. No reason was given. I have already sent the letter of medical necessity signed by my LLMD. Any ideas on what I should try next?
A: Meg wrote: Ask your insurance rep what the procedure is for an appeal. My doctor has to call each year and then Benicar is covered at 40mg every six hours as she has ordered.
There is no advantage in mentioning the Marshall Protocol because this is an unknown treatment plan. The emphasis should be on the fact that your doctor is in charge and s/he has determined that you should take Benicar.
& ...Your doctor has a license to practice medicine. He doesn't owe the insurance company 'bean counters' any explanation regarding that practice. He just needs to reassure them that he did not make a mistake writing the prescription and that, in his professional opinion, this is the dosage and schedule that this patient needs. Anything else he might say would put him in an unnecessarily defensive position. If they balk, claiming it is unsafe at that dosage, I suggest that he ask them to provide proof of their claim. It is his license that is on the line here; their interest is purely cost containment and he should feel confident that many other doctors are ordering Benicar at this dosage. If he is williing to accept responsibility for the way he practices medicine, they have no right to interfere.
& ... I write from the perspective someone who is very lucky to have excellent health insurance but I believe that my opinion applies to all insurance carriers. My doctor has never had to justify to my insurance company why she orders the medications she orders. She has had to verify, annually, that she wants me to take Benicar at higher than usual doses. She has not had to, nor do I think any medical practitioner should have to, justify, to insurance administrators, their reason for prescribing a medication. Medicine is an art and your physician is licensed to practice it as she/he thinks is in your best interest. I hope your doctor will stand up to any insurance official who says otherwise.
____________________
Barb: Dx Inflammatory Disease Endocrine Imbalance 2003| Depression| 24+ years not Dx| MP Aug04| ABC of MP| MP Search|
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Posted: Fri Nov 11th, 2005 21:23 |
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Insurance coverage for the Marshall Protocol
(filelink)
In the USA, private insurance coverage varies widely. Federally-funded and state-funded plans also vary in their coverage.
Doctor visits are covered by insurance with the usual deductible and co-pay stipulations. These visits do not need to be frequent. Many doctors encourage their patients to get routine information and support from our websites. Other routine labwork to monitor organ function is usually covered by insurance.
The D METABOLITES TESTS have been covered without question when using the codes listed.
If you have medication coverage, most insurers will cover the cost of 40mg of Benicar per day unless they require that you first try a less expensive antihypertensive. Commonly, insurers will initially refuse to pay the increased cost of the MP required dosage of Benicar 40mg every six to eight hours.
All insurers have an appeal process for claims that are denied. If your insurer refuses to pay for Benicar or refuses to pay for the dosage that the doctor has ordered, you need to find out the insurers appeal process. This sometimes only requires a phone call from the doctors office verifying that s/he has determined only Benicar will do and that you need the higher dosage of Benicar-no other explanation is required to 'override' the denial. Sometimes a form needs to be filled out, signed by the doctor and faxed back to the insurer to obtain an override. This override is usually good for one year.
Some insurers make this appeal process as difficult as possible (long waits on the phone, clueless sales reps, referrals to the wrong department, misinformation, lost faxed forms, etc.) so it may take some persistence on your part and your doctor's.
Most insurers do not cover medications considered experimental so it is important not to use that word. It is unnecessary for you to explain to your insurer why your doctor has ordered Benicar or a higher dose of Benicar. Explaining is your doctor's responsibility. Some insurers have decided that the Marshall Protocol is experimental so it is best not to mention the MP. The doctor should simply point out that s/he is licensed to practice medicine and in his/her best judgement, Benicar is the medication you need and this is the dose of Benicar that is required to help you recover.
It is worth fighting for your full insurance benefit because Benicar is a fairly expensive medication. Hopefully, your doctor will be eager to do battle with an insurer who would try to tell him/her how to practice medicine. Although the MP is considerably cheaper than the standard method of treating Th1 disease because no sophisticated testing or expensive IV medication is required, the logic of this reduction in expense means nothing to an insurer. Medication costs from the pharmaceutical industry have sky-rocketed and the insurance industry is always looking for ways to cut their medication reimbursement in the short-term.
Your pharmacist, whether local or mailorder, will refuse to fill the Benicar prescription if it is not on the insurer's formulary of medications or if there is a dosage limit until they get the override from your insurer which can pose an unexpected delay. Be sure you will have an adequate supply of Benicar before you begin the MP. If you get caught short of Benicar because of an unexpected denial for a routine reorder, ask your doctor for samples to tide you over while you complete the appeal process.
The other medications on the MP, are commonly used antibiotics and should not present a problem in insurance coverage. They can be ordered at the standard dosage and schedule without question to maximize your insurance benefit. Because they are taken at a lower dose and pulsed, they will last a much longer time. The doctor's instructions can simply say "take as directed".
Insurance plans do not cover the cost of NoIR or other recommended sunglasses.
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Posted: Fri Jan 27th, 2006 07:03 |
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Humana/Medicare part D approves Benicar at 120/month
From: katydid
I received approval from my Humana/Medicare Rx plan yesterday. The limit on Benicar is 30 per month. Believe it or not, I got the entire 120 per month approved, for one year.
I don't know whether this is due to the use of the letter from this site, slightly altered, or the fact that it took us forever to get through to them, due to the huge Medicare enrollment currently taking place. I sent them an email saying it was a good thing that what I needed was not for an immediately life threatening situation, and that I was not pleased with the service, as it took from the 4th until the 19th of January to get results.
I added a sentence to the paragraph that says that the optimal dose is 40 mg, every 6 to 8 hours. It said, "I have prescribed 40 mg every 6 hours, for a total of 4 per day, 120 per month, for Katherine."
I also added a letter of my own, saying that I had heard that this medication really worked for inflammation, from others with my condition. I also stated that I was on a very small fixed income from SSD. I don't know what did the trick, but I also have to thank my very persistent RNP. He's great!
Just thought to pass this on, wasn't sure where to put it, but I know Barb, or someone else will know!
Thanks to all moderators, and Dr. Marshall!
Kathy
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Posted: Thu Mar 9th, 2006 07:50 |
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Letter for insurer who denies Benicar dosage
Dear
The use of an ARB for treating chronic disease is off-label, but the dosing is not "outside FDA approved guidelines." If you look carefully at the the Package Insert you will see that there is no maximum safe dosage determined for Benicar, only a dosage level based on efficacy in the hypotensive indication. The full FDA evaluation of the product is contained in the NDA 21-286 (new drug application) which can be examined online at the FDA's website
http://www.fda.gov/cder/foi/nda/2002/21-286_Benicar.htm
You will note that clinical trials of the drug pharmacokinetics up to dosages of 320mg are contained in the NDA documentation.
A copy of the documentation submitted to FDA OOPD in support of designation of Benicar for the orphan indication of Sarcoidosis is at URL
http://AutoimmunityResearch.org/orphan-app-benicar.pdf
You will find a recent paper detailing Benicar's actions in the immune system at "Theoretical Biology and Medical Modelling" URL
http://www.tbiomed.com/content/3/1/1
Finally, in addition to the above documentation, in addition to the papers which have been published in peer reviewed journals, Dr. Trevor Marshall Ph.D, has been in close contact with the FDA on this issue. Indeed, he was selected to give a lecture in FDA's "Visiting Professor" series to the FDA Headquarters staff in Maryland on March 7, 2006.
I would therefore ask that you contact your "Board of Pharmacy" and tell them that there has been an error, and that the package insert language does not say what you represented in your letter/statement to me. Indeed, FDA staff regard this drug as one of the safest in the formulary.
Sincerely,
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Aussie Barb
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Posted: Sun Oct 22nd, 2006 20:42 |
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Dr. Marshall's Research Papers PAPERS FOR PHYSICIANS
Dr Marshall wrote: Our work has been peer-reviewed extensively, and been gone-over with a fine-tooth-comb.
Our JOIMR papers, for example, use open peer review, where the reviewers shed their anonymity to ensure the integrity of their reviews - take a look at the peer-reviews at the bottom of this paper:
http://www.joimr.org/phorum/read.php?f=2&i=38&t=38
Additionally, all our conference abstracts and journal publications have been peer-reviewed. Here is a list of some of the work I have published over the course of nearly 25 years
http://www.trevormarshall.com/papers.htm
I have recently been cleared by a CME (Continuing Medical Education) committee as being competent to participate in providing CME training for physicians. <<<
see this thread Benicar refused by insurance
Dr Marshall says "if you just give them that one new citation, my presentation to the FDA, then they will understand that their denials could lead to big time trouble. Or they could be totally absolutely stupid, a possibility one obviously can't always exclude
Marshall TG: Molecular genomics offers new insight into the exact mechanism of action of common drugs - ARBs, Statins, and Corticosteroids. FDA CDER Visiting Professor presentation, FDA Biosciences Library, Accession QH447.M27 2006
Tell them to request a copy of that transcript from the
FDA Biosciences Library,
U.S. Food & Drug Administration
5600 Fishers Lane Rm 11B40 HFD-230
Rockville, MD 20857
Our Presentation at the FDA CDER is online
The only ARB which works well enough to induce remission is Benicar. The reasons for this are complex, beyond the comprehension of the average physician."
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Barb: Dx Inflammatory Disease Endocrine Imbalance 2003| Depression| 24+ years not Dx| MP Aug04| ABC of MP| MP Search|
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Posted: Fri Dec 8th, 2006 14:38 |
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More information in these threads:
(filelink)
LH1953 is a Member Advocate US: Lori will assist you with your Benicar Insurance claims. You may wish to make contact by private message.
MEDCO refusing Benicar
Benicar refused by insurance
URGENT- I need to know who has been refused Benicar
Medicare Drug Plans
U.S. MPers--2007 Medicare Part D Drug Coverage
Humana, AARP, RxAmerica?
Problems with Medicare D to obtain MP meds?
Appeal denied for insurance, need help
HOW TO OBTAIN INSURANCE BENEFIT FOR FULL DOSE OF BENICAR Letter of medical necessity & Consent to Treatment form & letter to insurance company
BENICAR: Where to purchase Benicar for self-pay members
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Posted: Fri Jul 20th, 2007 05:21 |
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(filelink)
Tips To Effectively Battle Your Insurance Company
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Current time is 20:55 | |
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