Woman turns to Ted when insurance won't cover $6K MS drug

HOUSTON, Texas (KTRK) -- A Houston woman needs to take medicine daily to keep her multiple sclerosis in check, but the monthly cost was out of reach and for some reason so was the drug company's offer of financial assistance.

Carol Grant has lived with Multiple Sclerosis since 2013, and aside from occasional fatigue and some cognitive issues, she is managing it well.

Grant said it's in no small part to years of a daily dose of the MS drug Aubagio.

"Well, they advise you not to miss it," Grant said.

"Have you missed it," 13 Investigates' Ted Oberg asked her.

"Yes. I have," Grant replied.

That's because the drug costs more than $6,000 a month. Grant's health insurance has a $6,000 deductible, so until she paid that much in health care costs her insurance wouldn't pay anything.

The drug company does have assistance plans but they're mostly for co-pays, not deductibles. Blue Cross Blue Shield said it no longer accepts drug company offers towards deductibles, making the drug company's offer hard to use.

After numerous calls from Grant - and time running out for her new dose - we called the insurance company, the pharmacy and the drug manufacturer.

Blue Cross Blue Shield of Texas told us they cannot discuss individual cases, but sent a statement that partly said, "we are continually working to improve our processes and those of our vendors to ensure our members claims and refill requests are handled appropriately. When we identify gaps in our processes, we promptly address them as we are committed to providing our members with the highest possible level of service."

The drug maker, Sanofi, similarly couldn't talk about Grant's case, but told us, "We offer a copay assistance program for Aubagio which enables eligible patients with commercial insurance to receive it at a $0 copay. In addition, Sanofi offers a patient assistance program where qualifying uninsured or under-insured patients receive Aubagio free of charge."

Both companies were eager to have the case resolved and so was Grant.

"I finally got my medication," Grant said. "The reason why I think I got it, it's because I reached out to you."

It's unclear how Grant's medication was actually paid for. Her statement shows thousands paid some months. She didn't pay. She wonders if her insurance company used the drug maker's coupon and still tried to charge her the full deductible. We asked for clarification a week ago but haven't heard back.

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