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Post by sportsrancho on Nov 30, 2017 13:01:51 GMT -5
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Post by sportsrancho on Nov 30, 2017 13:05:04 GMT -5
2017 Appeals Letters... Fighting for Diabetes Meds I Need I've wanted to share these two appeal letters that my doctor and I crafted in order to get the needed insulin. Clearly, this is our decision. Non-medical switching isn't cool, and I don't want to be a part of it. When it comes to my medicine and health supplies, my doctor and I should be the ones deciding what's best for me --not an insurance company or Pharmacy Benefit Manager (PBM) and insurer that sets a formulary. And so, once my insurance company offered an initial denial for each of these requests, we fought back. For the sake of #PrescriberPrevails -- because this is our choice to make, not anyone else to make. That is basically practicing medicine without a license, and that's illegal. Here are my two appeal letters, one for Afrezza inhaled insulin and another for Tresiba basal insulin. Both succeeded in getting coverage from the said insurance company. My Afrezza Appeal Letter drive.google.com/file/d/0B05u4rlsHt-iTjhHTExIZTlmSTQ/view?usp=sharingMy Tresiba Appeal Letter drive.google.com/file/d/0B05u4rlsHt-idE9iNkVmY2k4bHM/view?usp=sharingHope these are helpful, for whatever they're worth to people. It all comes down to #DiabetesAccessMatters, #PrescriberPrevails, and #KeepMyRx. My doctor and I should be making these decisions, not anyone else. |
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Post by xanet on Nov 30, 2017 13:27:45 GMT -5
Fabulous!
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Post by promann on Nov 30, 2017 13:34:14 GMT -5
Awsome!
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Post by dreamboatcruise on Nov 30, 2017 13:44:50 GMT -5
Being able to cite the STAT study (assuming it shows what we believe it will) is going to be a good bit of ammo for these types of letters I'd think. Wish we knew when that will be published.
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Post by cedafuntennis on Nov 30, 2017 15:39:23 GMT -5
Did you try to contact Mannkind and Mike? They have been of fantastic and immediate help in the past.
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Post by sportsrancho on Nov 30, 2017 16:37:25 GMT -5
Did you try to contact Mannkind and Mike? They have been of fantastic and immediate help in the past. We all follow each other on Twitter, they know:-) and are in close contact. |
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Post by sportsrancho on Nov 30, 2017 16:47:58 GMT -5
They see all:-)
Get back with in minutes.
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Post by madog365 on Nov 30, 2017 16:59:17 GMT -5
Mike said that a new large insurer would be covering Afrezza starting in 2018. Do we know who that is yet? Aren't all the formularies out by now?
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Post by frumenti on Dec 6, 2017 14:03:18 GMT -5
I just found that you can appeal the tier your drug is in. I AMD T2 on Afrezza. Health Net Violet 2 has Afrezza in their formulary. They have Afrezza in tier 4 which costs me $90 per month copay. I can get Afrezza for a Copay of $37 per month if I can be successful with a "tier appeal". Afrezza is cheaper than Humalog so there is no financial reason for my insurance company to deny my appeal. Humalog is tier 3 and Afrezza is a tier 4 drug. Anyone have a successful appeal letter that I could copy?
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Post by liane on Dec 6, 2017 14:25:16 GMT -5
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Post by sportsrancho on Dec 6, 2017 20:22:52 GMT -5
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Post by sportsrancho on Dec 6, 2017 20:24:05 GMT -5
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Post by peppy on Dec 6, 2017 20:28:49 GMT -5
Mike said that a new large insurer would be covering Afrezza starting in 2018. Do we know who that is yet? Aren't all the formularies out by now? did he say we will know in January? it was a conference call. There is a transcript. He did say it. January or feb 2018? is my memory.
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Post by peppy on Dec 6, 2017 20:30:03 GMT -5
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