Rheumatoid Arthritis Support Group

Rheumatoid arthritis is a chronic, inflammatory, multisystem, autoimmune disorder. It is a disabling and painful condition which can lead to substantial loss of mobility due to pain and joint destruction. The disease is also systemic in that it often also affects many extra-articular tissues throughout the body including the skin, blood vessels, heart, lungs, and...

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Insurance denied MTX

Kimhurts
Kimhurts

Ok. Get this. I have been on MTX 25 ml injectable for 5 years, BUT it has been under the brand name OTREXUP because it is the pre-filled auto-injectable pen. It is just too expensive, so I decided to go back to the regular syringe and vial kind. The pharmacy just called me to tell me insurance denied it because standard dose is only 9 ml per week! What? Where did they come up with this number? 

Bluegal62
Bluegal62
Have your doctor fight it, citing all the previous Rx that were filled. Unless they sent you a change in insurance policy or something then why change it? Its crazy how these things seem to happen, changes in insurance policy that is, without anyone being informed
Kimhurts
Kimhurts
The fight is already in progress. This defies logic. To my knowledge, no change in my coverage and I MOVED TO A CHEAPER MED! They prefer the more expensive one?

My doctor is at a busy university hospital. He does research. He doesn't have time for these games. I feel bad calling and asking, but I have to. He is nice about it, but I feel terrible. He must be used to these games. They still frustrate me greatly. I have a headache. It would be great to relax with a glass of red wine and forget all of my insurance trouble right now, but I can't because of the MTX. Crangrape juice in a wine goblet just doesn't do the same job.

I keep telling myself that I am grateful to have insurance. Having trouble with that one today.
Frazzled
Frazzled
Sorry you are going through this, Kim. Keep fighting...your health depends on it. I know it can be frustrating. Keep pushing...
Kimhurts
Kimhurts
Just got it approved!

I take my victories where I can get them.
SoTired84
SoTired84
Kimhurts.. so glad you got approved.. Insurance company's know that they can do what they want because they know we need these drugs... I have fought several times now with them because they won't approve my headache meds or the Lidoderm patches... finally had to buy them without ins. ugh...
MarleneJ
MarleneJ
Oh, that sounded just dreadful! I am on 15 mg injectable mthx, because my liver can't take more. It is not enough. What is 9 ml anyway? 2.5 is the normal increment of one on a diabetic syringe. So 3.6 increments? How on earth would you even do that.

I'm so glad to see the update, and that you got the right dose. I am so glad I am in Canada, where Insurance gives what the doctor prescribes, and pays for it. Way too much nonsense in the US.