FUDiabetes

Getting approval for Afrezza with UHC/Caremark

When my doctor prescribed Afrezza, I got a call almost immediately from my pharmacy that it wasn’t covered. My doctor had anticipated this, so we continued going through the steps to get started - set up an appointment with the Afrezza rep and also an appointment for the lung function test (which was quick and simple, and I passed).

The Afrezza rep had a form to submit to Mannkind Cares, the company that helps patients get approval from insurance for Afrezza. In the meantime, they also offered a voucher for a free 30 day supply (90 cartridges).

The next thing I heard was that my insurance required me to do a 30 day trial of Novolin R to prove it didn’t work. I was on Novolog at the time, so they just wanted me to try every option in their formulary and fail before they would approve the Afrezza. I picked up my prescription for the Novolin R, and by the time my next appointment came around, just over a month had passed, and I was able to tell my doctor the Novolin had not worked for me at all (not surprisingly!). She passed that information on to my insurance.

The Afrezza rep contacted me shortly after to confirm I hadn’t received word I’d been approved; I said no. She said she was working on trying to get it approved and would let me know when it did. A week later, she contacted me again to say she had just learned the approval had gone through!

Of all of the fights I’ve had trying to get different things covered by insurance, this was by far the easiest on my side - the Afrezza rep and my doctor had to do a lot of the paperwork and pushing to get things put through; most of what I had to do was just be patient and wait out the process.

So if you are trying to get approval for Afrezza, be sure to see an Afrezza rep, make sure they are submitting a form to Mannkind Cares, and definitely take them up on the free month’s supply!

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@Sam, any other details you’d like to see?

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Not that I know of! I have a member funded insurance plan and cvs Caremark who is their pharmacy benefits manager initially denied my rx-- but I was able to contact the actual plan coordinator for our plan (the one who contracts caremarks services) and she was able to enter a manual over-ride… it was really simple once I knew how to go about it. Important thing is people just pursue as necessary. A cooperative doctor makes all the difference in the world too.

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Ah, yeah, I should change my header; forgot about Caremark. That’s who we go through for pharmacy…don’t know why I can’t ever seem to remember that!

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It is OUTRAGEOUS that an insurance company or pharmacy plan would make you prove to them that an inferior drug (novolinR) would not work for you when your doctor clearly wanted you to be taking Afrezza.

That our medical care system has been so bastardized and taken out of the hands of Doctors and such power given to bean counters is maddening.

Not to get political, but one party let it get out of hand and the other party drove in the final nail. It’s time for us, the medical consumers to tell them all to go suck an egg and demand that it be done correctly.

/rant

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That sums it up. It’s also why I’ve been paying out of pocket for my thyroid meds for…well, a long time.

I called to get my refill on Afrezza today…and was told that my prior authorization has expired, and insurance once again offered Novolin R as my alternative (denied coverage on the Afrezza). I can’t fathom why in the world that’s always the suggested alternative…

…and I’m really praying we can quickly get back to my $15/month copay, because I’ve only got 10 cartridges left, and I normally use 2/day. Good thing I’ve been trying to cut down on grains (and thus carbs) lately… :anguished: