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Attention Xeljanz Users!! New Alopecia classification leading to denial of coverage
Bad news for those of us using Xeljanz with health insurance. In August of this year, health insurance companies - Blue Cross Blue Shield Care First, specifically - reclassified Alopecia as a cosmetic/ aesthetic condition, rather than a medical condition/ disease. Consequently, they will no longer cover Xeljanz treatment because it is deemed cosmetic.
I'm considering suing. If anyone else has had their coverage of Xeljanz recently denied (since August 2019), please let me know.
Replies to This Discussion
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Permalink Reply by Elizabeth W on
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My dermatologist prescribed Clobetasol Propionate 0.05% Solution 25 ml, but when I tried to refill it at my Walgreens pharmacy my prescription drug plan (Medicare Part D) would no longer cover it., so she switched me to Mometasone Topical Solution. I'm not sure which is better. Clobetasol's retail price was $96. (I paid a copay of $32). Mometasone's retail price is $64.) I guess every drug plan is different in what they charge. I will have to start satisfying my $400-plus deductible tomorrow.
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Permalink Reply by Sam on
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Hi Susan, I don't frequent this site too much, but I was interested in your above post. How well did the Cream work? And how did it work? Xaljanz did not work for us at all. Very frustrating!
Just curious on your results. Thanks.
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Permalink Reply by DJ88 on
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Is there anything we can do as a community to help appeal this? People have to understand this isn't only cosmetic. Having a sudden outbreak of AU can damage someone's mental health.
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Someone has to alert American NAAF. The insurance problem (ie labeling AA as "cosmetic") can cause pharma industry to cease further development of AA medication. Also the insurers and public health providers will start denying cover for wigs as they start doing it in the EU (started in Germany), respectively they will only cover very cheap ones. So the ladies will have problems in the future too. The NAAF like organizations in the EU are not bold enough to take care of this problem. The american NAAF needs to take care of that. A precedence legal case needs to be created with top notch dermatologists like Brett King as experts. Once one case is won in the US the entire insurance industry world wide will stop denying cover.
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So as an update, a couple members recommended a Xeljanz equivalent (not necessarily generic, since there are no generics yet), called Tofacinix which is available from Beacon pharmacy in Bangladesh. http://www.tofacinix.com/index.php
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Permalink Reply by Renee on
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You can have mine. I have a ton of it because it didn't grow 1 hair for me.
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You guy should apply for the Pfizer Assistance Program, they have paid for my years supply of Xeljanz and will also do so next year
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There is a pharmaceutical copay assistance program through manufacturer. Medication still has to be authorized by insurance (BCBS in this case) first for that to kick in. They waive the copay and recoup the balance from insurance.
There are other need based assistance programs from manufacturer, but despite very intrusive paperwork, most folks rarely qualify.
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https://ra.xeljanz.com/rheumatoid-arthritis-support-resources/co-pa...
This is the link to get copay savings card I have used, there is also information for folks on government programs like Medicare or Medicaid and for need based free medication.
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