Express Scripts

I am in quite a unique situation and just want to know what else I could do. So I am 24 and have Crohn’s disease, what my doctor has called the most severe case he’s ever had to treat. I go to the Mayo Clinic in Rochester Minnesota every 6 months for scans, colonoscopy, ileoscopy, and bloodwork. I am from a small town in Alabama and there are not many reliable IBD doctors around here that I can depend on for a concrete treatment plan. I am on Rinvoq for my Crohn’s and while it does help, I still have some problems (perianal fistulas) that doesn’t allow my ileostomy to be reversed (my final goal). Last visit to Rochester, my doctor suggested a dual biologic therapy of both Rinvoq and Skyrizi. He submitted a prior authorization for Skyrizi which was denied within 24 hours. He submitted and appeal which was denied, and then another which was denied. Finally, there was an option for an external review by a medical review board and they overturned the insurances decision for coverage. Now it gets complicated. The doses they overturned were the infusions, which are the loading doses for Skyrizi which last 3 months. These doses go through my health insurance. I also had to get a prior authorization approval for the maintenance doses which are through my pharmacy insurance, Express Scripts. So I have taken my first loading dose of Skyrizi and it is a night and day difference for my Crohn’s, and I feel better than I ever have. My problem is the Mayo Clinic submitted a prior authorization for the injections of Skyrizi (the maintenance doses) to express scripts and it was denied. They then submitted an appeal and included literature including clinical trials showing success using these medicines in combination with one another and including the decision from the medical review board for the infusions showing where the review board stated “while biologics are not usually used in combination with one another, this patient’s advanced disease provides a unique case in which both medicines would be acceptable to be used in conjunction with one another” and that appeal was submitted Thursday around 2:00 and by 10:00 on Friday the appeal had already been denied. They didn’t state a reason besides the medicines shouldn’t be used together and added a little footnote at the bottom of the page that said “this is a final decision. No additional appeals or external reviews of this determination is available.” Is this okay for them to do? I fought tooth and nail for the infusions and it took over 3 months of going back and forth to get those, I feel like it is very grimy to not allow an external appeal or anything else, just one and you are done. I also feel like quantum health, my health insurance, may have told them to add that because when I called express scripts I was given an address to send a second level appeal so I know they are available, just not for me. The Mayo Clinic said the only option now would be for me to get on abbvies Skyrizi bridge program, which covers 100% of the medication until insurance starts to pay. And while that is good that I will still get the medicine, I feel like it is not right for them to not even allow another medical review or anymore appeals for ME, but they’re available for other medicines and people. Can they do this?