Sunday, August 10, 2014

Obtaining Auvi-Q Epinephrine Auto-injectors - Problems and Solutions

Top: Auvi-Q 0.15mg - Box and Contents
2 Active Devices, 1 Trainer Device and accompanying printed materials
(Updated to add:) Bottom: Auvi-Q Vouchers

Here's a summary of the recent problems that parents and caregivers have been having, 
when trying to obtain their Auvi-Q EAIs, along with possible solutions:
(This information pertains to patients in the U.S.A. and is presented to the best of my knowledge. 
Offers and conditions can change at any time, so please check directly with the pertinent company if you have any specific questions.)

Problem: I am having trouble getting my Auvi-Q prescription covered by my insurance company.

Solution(s): Patients can have their doctors submit a Statement of Medical Necessity to request "Prior Authorization" for the Auvi-Q. For Express-Scripts, your doctor can visit this website to submit the request by phone, or online. The following is an except from that form, showing some of the reasons that may qualify someone for an exemption:

If you have another prescription provider, you should still be able to use this form. Sanofi's Patient Connection site has other forms that might also be useful for appeals, etc.

Want some even better news? As of 1/1/2015, the Auvi-Q will return to the Express-Scripts Formulary, as a "Tier 2" medication, meaning it should be covered by most insurance plans! They were finally able to overcome the exclusivity contract brokered by another epinephrine manufacturer, and now freedom of choice has been restored to families in search of epinephrine! This change has already taken place with Caremark, as of 7/1/2014. (Updated to add: As of 1/1/2015, the Auvi-Q will also return to Tier 2 status for those covered by Aetna Value and Aetna Premium insurance plans!) If you use another prescription provider, contact them to let them know that you want the freedom to choose the life-saving device that you feel best suits your family's needs.

The $100 Co-pay Card offer will also still be in effect for the foreseeable future, but you can always get the latest information at It offers $100 off the insurance co-pay, or $100 off the retail price for those paying out-of-pocket.

Problem: I was able to obtain a prescription for my Auvi-Q, but the set(s) I received from the pharmacy expire(s) in less than 12 months!

Solution: Fear not! Sanofi, makers of Auvi-Q, are offering a generous resolution to this issue.
Oh Mah Deehness posted this tidy summary of the information that Connie Green and a few of us received from Sanofi on the issue: "Patients or caregivers who, within the last 31 days, purchased an Auvi-Q that expires in less than 12 months are eligible to receive a savings card with a maximum benefit of $400 off one two-pack of Auvi-Q for each Auvi-Q purchase that meets the terms and conditions. Savings cards are valid for use January 1 – June 30, 2015.  Patients or caregivers who purchased an Auvi-Q in the past 31 days with 6 months or less of dating may receive a replacement Auvi-Q or they can opt to receive a savings card.  For more information, including terms and conditions, patients or caregivers should call Sanofi Customer Service at 1-800-633-1610." (If that number doesn't work, you can also try 1-800-207-8049, Option #5 and then Option #1. Thanks for the tip, Julie Brown!) Note: "In the past 31 days" means that you need to submit your request within 31 days of your invoice date, not within 31 days of the blog post.

I called the number when my EAIs arrived with an expiration date of April 2014. I was asked to provide visual proof of the quantity purchased, expiration date, lot number and the invoice date. To do so, I took a photo of the bottoms of my Auvi-Q boxes and a snapshot of my invoice from Express-Scripts. I was given an "Inquiry Number" which was required for submission. They offered me the choice of submitting the information via email or fax. It was a 6-minute phone call, according to my phone, and it took me another few minutes to send the email, so I'd call it a 10-minute process, tops. This is a pretty amazing deal, considering that my devices are good for 9 months and when I request my sets using their vouchers in June 2015, they could be good for another 6-12 months, providing me with 15-21 months of epinephrine coverage for that single co-pay! (Also, I could have used their $100 co-pay card to cover that cost, but was simply done with dealing with Express-Scripts and just let is slide.) (Updated to add: I received by $400 vouchers in the mail! It took 20 days for them to arrive, which is no problem, at all, given that they are not valid for use for another 4 months.)

Problem: I am unable to afford my (or my child(ren)'s) Auvi-Qs.

Solution: Epinephrine is a potentially life-saving medication and no family at risk for anaphylaxis should have to forego it, during times of financial hardship. The Sanofi Patient Connection site has information and a form for the Patient Assistance Program. Some may be surprised to learn that they qualify for assistance under this program. The form includes a complete list of requirements, but, for example, the income requirement for a family of four is that it be under $59,625. (This is 250% of the U.S. poverty level at the time of this writing.) It's worth looking into, if financial strain is an issue.

Those at risk for anaphylaxis, and those who care for them, must have epinephrine on hand, at all times and they should have at least 2 doses. Please do not let anything or anyone stand in your way of getting what you need to protect yourself or your loved ones.

Disclaimer: I am not a doctor, nor a medical professional. Always consult with a doctor before making any healthcare decisions. This is not a paid post. A year ago, I attended a summit at the Auvi-Q headquarters, along with other bloggers, as invited guests with expenses paid, to see the Auvi-Q before its launch. We were never, and are not currently, under any obligation to write about or promote the Auvi-Q.

Friday, August 1, 2014

New Back-to-School Resources from the Makers of Auvi-Q Epinephrine Auto-injectors

Disclosure: I was once an invited guest, along with several other bloggers, to the Sanofi HQ, to preview the Auvi-Q®, before its initial release. I am under no obligation to write about the Auvi-Q®, nor am I obligated to write anything favorable. My opinions are always my own and I write about things that I truly believe in and trust. I am not a medical professional. Always consult with a board-certified allergist about issues relating to anaphylaxis and food allergies.

Screenshot from the "Explore Auvi-Q®" Video
Sanofi US, makers of Auvi-Q®, have released some great new resources, in the form of quick and informative YouTube videos. As you watch the first YouTube video, "Explore Auvi-Q® (epinephrine injection, USP) and Related Resources and Tools", look out for links to helpful items, such as these:

  • Anaphylaxis Action Plan
  • Severe Allergy & Anaphylaxis Playbook
  • Auvi-Q Savings Offer
  • Auvi-Q Mobile App
  • Auvi-Q Demo Video

They also have two new Patient Stories videos:

These videos include interviews with parents who have actually used the Auvi-Q®, along with the inventors of the Auvi-Q®, Evan and Eric Edwards, who both grew up with anaphylactic food allergies.

One particular item I would like to recommend is the Auvi-Q Mobile App. It can act as a training device, on -the-go, and I love how it senses the change in position of your phone to simulate the use of the device. It also has a training module in Spanish. The voice instructions are still in English, but the written guides are in Spanish, to help Spanish-speaking caregivers/patients. There are several other great features on the app, so be sure to check it out!

Good luck with your Back-to-School planning!  

Note: For those who have received Auvi-Q® prescriptions from your pharmacists, in the past 31 days, with expiration dates earlier than 12 months in the future, there is good news! Please head on over to Oh Mah Deehness! to view Homa's post on contacting Sanofi to receive a $400 voucher towards the purchase of replacement devices, for when the short-dated devices expire. These vouchers are valid from 1/1/2015 - 6/30/2015. I completed this process, this morning, in under 10 minutes! 

As for those who, like me, have been lamenting the difficulties in obtaining coverage for the Auvi-Q® from certain prescription providers, such as Express-Scripts, from whom we obtain our medications, there is some hope on that front, as well. Your allergist/doctor can contact Express-Script's Prior Authorization line and request a Clinical Exemption, under certain circumstances. Sanofi also has forms available on their Patient Connection site, which you can use for other providers, or if more than a doctor's phone call is required.

Monday, May 12, 2014

FeNO Testing - Asthma Management Tool

Disclaimer: I am not a doctor, nor a medical professional. I am merely sharing information on a test that I had done for my daughter, to assess her asthma management protocol.  Please consult a doctor with any medical questions or concerns, thank you!

As I wrote about in my post about Qvar, I have been pleased with its effects.  I had heard about FeNO testing, and asked our allergist about having it done for my daughter, as a way to gauge her progress.

What is FeNO testing?  FeNO is short for "Fractional Exhaled Nitric Oxide."  According to Wikipedia, "Nitric oxide (NO) is a gaseous molecule produced by certain cell types in an inflammatory response."  It can be used to determine whether symptoms shared by other conditions can be attributed to asthma, and can also give an indication of whether the patient would benefit from Inhaled Corticosteroid (ICS) treatment.  Another use of FeNO testing is to gauge how well a course of treatment is going.

We pursued it for the latter reason, since my daughter had been on Qvar for over a year.  The device used was the Niox Mino.

The Niox Mino
At our appointment, they had my daughter, who is 5 1/2 years old, sit in front of the machine, which was placed on a desk.  They attached a disposable mouthpiece and instructed her to place her lips on it and take a deep breath in from the machine, until an indicator told them it was good and then she was told to breathe out for about 10 seconds.  It took us a few tries, but she got it and they were able to get a good reading.

This process was different and not as "exciting" as the Lung Function Test she had done, previously, where she was able to blow out birthday candles and make a balloon float across a waterway.  There isn't really a "kids' version" for the FeNO test, but it was over and done with rather quickly, so that was not an issue.

We waited in the room for a bit and the allergist came back and said that her results were just fine.  Her reading was 6 ppb. (Yay!)

Here's what is listed on the literature available on their site, for a reading below 20 ppb, for a child under 12 years of age, who is asymptomatic:
  • Implies patient is adherent to treatment 
  • Consider dose reduction, or in case of current low ICS dose, consider ICS withdrawal altogether (repeat FeNO 4 weeks later to confirm this judgement; if it remains low, relapse is unlikely)
We are definitely adherent to the treatment plan.  I can't say we never miss a dose, but it is a rare occurrence.  She is currently on two 40mcg puffs, twice daily.  Though the allergist did not bring it up, we could consider lowering her dose and/or tapering off, but I am not going to pursue that, just yet, and we will discuss it at her next appointment.  

My only minor concern with taking the test is that my daughter sprouted two very small pink spots on her face after the test and the thought occurred to me that she had to take in a deep breath from the machine.  I was concerned about "shared air", so I called the makers of the Niox Mino.  They said that the internal chamber has an "NO scrubber" that removes NO particles from the previous test (for up to 100 uses, I believe) and the mouthpiece has a filter on it, so they didn't think allergenic particles would be an issue.  My daughter's spots may have been unrelated and nothing more came of it, but I thought I would mention it, since it was part of our experience.  

In any case, I am glad that I had the test done and it was comforting to receive a value only one tick above the minimum detectable level.  Whether this proves to be because the Qvar is doing its job, or because she has improved to the point of no longer needing the Qvar, remains to be seen.

Has anyone else had FeNO testing done?  Did you find it helpful?