Biologics prior authorization
My husband has severe plaque psoriasis a condition that affects his immune system. After being on Humira for 10 years he was switched over to the biosimilar Hyromiz. While this specialty drug is a plan exclusion they have an active PA and it was filled last month for his loading dose. They're asking again for a new prior authorization how can't they even do this? The providers office is sending prescriptions to a pharmacy that I have never even heard of that's out of network who has made 4 attempts to get a citrate free pen prescription and meanwhile I have our actual insurance prior authorization department saying they have received no response on the "additional information" request so it's denied but wait I can't appeal it because it's not a "true denial". This has been an ongoing nightmare since June. He went to the doctor in March covered in psoriasis and between now and then he's only received the medication twice (both being a loading dose due to the gaps in treatment) I've tried switching doctors I have gone in person and talked to the provider so many times they won't switch the prescription and they won't talk to the insurance company. I don't know what to do anymore please help
submitted by /u/Yoshic12
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