My Step Therapy Exception was denied even though I’ve unsuccessfully taken 4 drugs in the same class…..they want me to try 2 more
*Throw away account*
Hello. I’ve long been diagnosed with Bipolar II. I tried Abilify, Geodon, Seroquel, and Vraylar, all of which came with severe side effects and little to no efficacy. Finally in 2014, we tried Latuda. It was like a miracle drug. My depression went away along with my suicidal ideations, and I haven’t had a hypomanic episode since. It literally saved my life.
Up until 2021, I never had an issue obtaining it. Health plans covered it with a high copay.
Then at a new job, it required a pre-auth. Denied despite my history of other drugs not working and long history of success. Appealed. Appeal denied. I started having to pay out of pocked. Latuda is $2,100 out of pocket. Well, it’s either I pay that or I kill myself. Easy decision, but it’s a crippling expense.
Recently changed insurance to a platinum PPO. $300 deductible, $0 employee contribution, $1100 a month for the employer. Latuda is covered at the Tier 3 level. 90 days supply is $100. I finally thought I would get it covered! They had a step therapy requirement which me and my Dr thought shouldn’t be a problem considering I’ve been on four other drugs with no success, all of which are listed in their own formulary as alternatives to Latuda.
DENIED
They want me to try Risperidone and Zyprexa before they will approve my Latuda.
So six different failed drugs before they will approve the one that has worked like magic for 8 years and the one my Dr recommends.
What the hell has health insurance become in this country?
