Cigna now denying biologic medication (Stelara) after previously approving it
I have been prescribed the biologic medication Stelara for Crohn’s disease. The first dose of this medication is given as an IV infusion, followed by injections every 8 weeks. I have Cigna Open Acess Plus with Wellcare New Jersey as secondary. After many weeks of back and forth with Cigna, Accredo specialty pharmacy, and my GI office, I was finally told that both the initial infusion by a home care nurse as well as the injections every 8 weeks were approved and I received the infusion on Nov 21. On Dec 9, I got an email from Express Scripts (parent company of Accredo) that the delivery of the next dose has been cancelled. That afternoon, I called Express Scripts first and was told the reason was it exceeds maximum allowed cost. Then I called Accredo directly who said that was not the case, it’s because they never received a prescription from my GI. My GI agreed to resend it while insisting they already did. Today I called Accredo again and now they are claiming it has nothing to do with the prescription, it IS denied for exceeding maximum cost. I am really confused and not sure what to do next. Should I contact the Stelara withMe program? I would really appreciate any advice!