Health Boards
Sat-29-06-2019, 21:46 PM
Well, it will be Monday before I inject. Received a letter today from my prescription plan. It states the following:
"We have declined on behalf of your plan to provide benefits, in whole or in part, for Taltz autoinjector 80 mg/ml AUTO INJCT."
The reason listed is:
The requested drug is NON-PREFERRED and coverage is not authorized under the plan. The non-preferred drug is covered when documentation has been provided that the patient has tried THREE of Cosentyx, Humira, Otezla, Stelara SC, and Tremfya.
Now I specifically told the specialty pharmacy to check with my insurance plan. So either:
A) I have a big problem
B) My prescription plan denying coverage doesn't affect the $5 - $25 copay (I was approved for the $5, although not sure why as that info came from the doctor's office)
But I will call them Monday before injecting because if they think I'm paying more than the agreed price, they will get it back!!! Although I don't think that will be the case, but I'm not taking any chances until I talk to them as I just don't know how this is working regarding insurance, payment, etc. I was assured my cost would never be over $25 so everything should be okay but still.... better wait and know for sure!
"We have declined on behalf of your plan to provide benefits, in whole or in part, for Taltz autoinjector 80 mg/ml AUTO INJCT."
The reason listed is:
The requested drug is NON-PREFERRED and coverage is not authorized under the plan. The non-preferred drug is covered when documentation has been provided that the patient has tried THREE of Cosentyx, Humira, Otezla, Stelara SC, and Tremfya.
Now I specifically told the specialty pharmacy to check with my insurance plan. So either:
A) I have a big problem
B) My prescription plan denying coverage doesn't affect the $5 - $25 copay (I was approved for the $5, although not sure why as that info came from the doctor's office)
But I will call them Monday before injecting because if they think I'm paying more than the agreed price, they will get it back!!! Although I don't think that will be the case, but I'm not taking any chances until I talk to them as I just don't know how this is working regarding insurance, payment, etc. I was assured my cost would never be over $25 so everything should be okay but still.... better wait and know for sure!