Sorry, just saw your message. I didn't appeal my insurer's denial of Xeljanz. In fact, it was necessary for them to deny it so I could qualify for Pfizer's Hardship Program. There are people on ADML's post who have appealed.
I did not have to appeal, but they do require a pre-approval from your doctor. Zeljanz is considered a 4 tier specialty drug and is covered at 50 percent if your doctor fills out the pre-approval forms. Make sure you choose a plan that has Zeljanz on their list of specialty drugs.
Hi Bee, I had to switch insurance too. I am now with my employer's ins., Carefirst BlueChoice Healthy Blue. They probably have different plans though. Mine covers Xeljanz at 50 percent and I applued for the hardship from Zelsource which pays the rest. Its worth applying, if you qualify, they will pay all of it if your ins. Does not cover.
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Hey Bee hows it going
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