Ocrevus Copay Assistance Revoked

Hi! 25F who doesn’t understand insurance very well and needs some help. Last year, I switched to my employer’s AETNA healthcare plan where specialty drugs such as Ocrevus are “handled” through my pharmacy (insurance?) OptumRX.

Long story short, I received a call from OptumRX saying I owe $1400 for my Ocrevus. Genentech took away my copay assistance (although they covered my Ocrevus this June) due to me being enrolled in a “maximizer/variable cost savings program” sometime between my last infusion in June and now. They mentioned they will only cover up to $125 worth of admin fees, despite having ~$13k of funding remaining for this year.

I do not recall ever being signed up or willingly signing up for this and I’ve spent countless of hours on the phone with both AETNA and OptumRX and they have no record of this in their system. Genentech stated that they do, and I need to provide a Benefits Summary/EOB showing that I am not enrolled in this program. OptumRX is claiming they don’t have anything like that and AETNA had to “draft something up” and fax it over to Genentech.

I’m finding it difficult to believe that I somehow without my knowledge got enrolled into an (anti) cost savings program through my insurance without my knowledge after no change to my insurance over the last year. No one on the phone from OptumRX nor AETNA have been able to help me.

Has anyone faced something similar, what can I do?