Does anyone else have trouble with their insurance paying for biologics? Right now I am twenty two days late for mine, waiting for preauthorization. Any suggestions to make this easier?
Some insurances really suck but most just have hoops to jump through for your doctor. If you can message your doctor's office to look into it, do so. If you have a crap insurance that wants to delay and say no if possible, the full court press is to call your doctor's office and speak with his nurse. Meanwhile call the insurance and bug them until they either comply or assign you a case manager who will also bug your doctor's office. If your insurance is through an employer, bonus round for calling HR and asking them to call insurance to inquire as to the delay. If all of the above doesn't move them, make a call to your senator's office and have them inquire as to the delay. Not likely to mess with your case twice. Make sure your ducks are in a row before that or you give them an excuse. My Humira is $12,000 per month so the delays are inevitable but going without medicine is not.
Just keep being a squeaky wheel! I had to try Methotrexate first before mine would approve Humira. Methotrexate didn’t work for me at all. My doctor decided to put me on Humira and got approval on the first try. I was surprised because I’ve heard of so many others getting turned down😖. Some insurance companies just choose to be difficult for some reason. Just keep pushing. And, if you do get approval, find out about co-pay assistance programs. The 2 dosepens I get each month would’ve been $6,000 without insurance😱 My co-pay was going to be close to $600/month. I couldn’t pay that. I called around to different foundations, charities, etc that help with what your co-pay doesn’t cover. After talking with several, with no luck (no funds at the time, covered Humira but not for PsA, yadda yadda), I got in touch with Humira Complete, they signed me up for a savings card and I pay $0/month!👏. Took 5 minutes!😄. Good luck to you!
i have the same problems, girl. i throw 100 fits dealing w them but i kinda came to the point of harrassing my derm to do the heavy liftjng for me by saying “yea you all have me playing phone tag so i give up and will just suffer in the pain” and i guess that was enough of a guilt trip for them to stop with the games. been to 3 docs and its the same thing everywhere u go gf
I just started Cimzia as my first biologic for recently diagnosed PsA. The first prior authorization request was denied for what I learned was an incorrectly filled out form. A relative contraindication from my medical history for the preferred Enbrel and Humira was omitted. I found out when I spoke the contracted specialty pharmacy firm doing the paperwork for my dermatologist. I was able to get the request approved after contracted firm filed a "reconsideration" with the omitted info in a Letter of Medical Necessity.
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