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My Current Psoriasis Medication Ordeal

Posted on November 10, 2021
See how 393 members reacted on this article
Article written by
Katya Meltaus

As I write this, I am more than a week overdue for my next dose of my current biologic, and there is literally nothing I can do about it. When I first decided to turn to biological treatment, I thought the majority of the stress would be over. I had made the difficult decision to start the drug and now I simply had to stick to my schedule. It seemed inconvenient that I had to call each month to order my next shot rather than having it scheduled in advance, but this was manageable as long as I could get my medication filled.

Specialty Pharmacy Woes

Making things more complicated, I quickly realized that the specialty pharmacy where I fill my prescription is extremely disorganized. I would regularly call to resolve an issue with filling my medication only to speak to another representative the next day who showed no record of the call. I found when I escalated to speaking with management staff, they seemed able to do more for me in overriding any system blockages that were getting in the way. However, no one I’d spoken with suggested this and I always had to insist.

For my new biologic Taltz (ixekizumab), the recommended dosing is 160 milligrams (two 80-milligram injections) at week 0; 80 milligrams at weeks 2, 4, 6, 8, 10 and 12; and 80 milligrams every four weeks thereafter. I was able to get my first three shots with minimal issues (the two at week 0 and one at week 2), but have been unable to fill my week 4 shot. I am now overdue.

Insurance Problems

After lots of back and forth between my doctor, the specialty pharmacy, and my insurance, I now have more information about why this is happening. My insurance will not approve more than 3 milliliters of Taltz every 63 days, even though the Taltz loading-dose schedule (as mentioned before) is greater than that limit. Why my insurance company and the medication manufacturer are not on the same page about this is unknown to me — and pretty frustrating. In between these two players, I have my specialty pharmacy with their own issues.

I talked to my insurance claims department and issued an appeal, and I have since had my next dose approved by them. However, my specialty pharmacy is unable to “release” my medication until something updates in their system. Unfortunately, no one at the pharmacy can explain to me what exactly is causing the delay or when it will be resolved.

Stress About Medication Access

I am thankful to be insured, to have a doctor who will advocate for me, and to have access to biological treatment, period. However, this past week-and-a-half has been pretty stressful. I only recently gained comfortability due to this drug, and now I am worried about if or when my symptoms will return, given the lapse in treatment and how often this issue will arise in the future. I am also fed up with the system, without really knowing where to direct this energy.

My insurance was clearly mistaken about the dosing and my pharmacy is ridden with system blockages, so what should be a fast and easy transaction often turns into a two-hour shakedown. It is currently not an option for me to choose a different specialty pharmacy to supply my biologic, but I am hopefully awaiting this prospect.

Due to this issue, I also now have a direct contact at my insurance company whom I can call when I have any appeals, which I am thankful for. Now I am awaiting a call from my pharmacy saying that they have released the medication and will be overnighting my next dose. I will take it as soon as it arrives and hopefully won’t notice any return of symptoms in the meantime. As for my shot after that, who knows what will happen!

MyPsoriasisTeam columnists discuss psoriasis from a specific point of view. Columnists' articles don’t reflect the opinions of MyPsoriasisTeam staff, medical experts, partners, advertisers, or sponsors. MyPsoriasisTeam content isn't intended as a substitute for professional medical advice, diagnosis, or treatment.

A MyPsoriasisTeam Member said:

Biologics are a long-term treatment plan. The idea is to build up the biologic slowly in your system, then maintain a steady "maintenance" dose. Missing a week here or there is not an insurmountable… read more

posted 7 days ago

hug

Katya Meltaus is an early childhood educator living in the Bay Area. She has been managing severe psoriasis for the past two years. Learn more about her here.

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