Hi everyone,
Have you all had issues getting specialty medications approved through Express Scripts?
My doctor just put me on Enbrel and my prior authorization was approved by CVS Caremark insurance, which I’ve been using through Cobra. I was going to go off of CVS Caremark this month though, and switch to Express Scripts through my new employer. I haven’t picked up the prescription yet.
I called express scripts and it seems their prior authorization requirements are stricter than Caremark’s, like I have to have failed Methotrexate in 3 months or have experienced ‘adverse side effects.’ I did try MTX and had terrible side effects but I don’t know if that was properly documented by my last rheumatologist.
It seems though that it’s easier to get Express Scripts to approve Enbrel if they see you’re already on Enbrel and experiencing improvement.
Have any of you had issues with Express Scripts? Should I just go ahead and stay on CVS Caremark Insurance through Cobra for one more month, get on Enbrel now, and then when I switch to Express I will already be on it so it’s easier to get approval? I just don’t want to end up sabotaging myself if I switch to Express now and then risk the prior authorization being denied. I imagine they will require me to try MTX again but I don’t want to do that and it would just waste time.
submitted by /u/OaksJoy9000
[link] [comments]Hi everyone, Have you all had issues getting specialty medications approved through Express Scripts? My doctor just put me on Enbrel and my prior authorization was approved by CVS Caremark insurance, which I’ve been using through Cobra. I was going to go off of CVS Caremark this month though, and switch to Express Scripts through my new employer. I haven’t picked up the prescription yet. I called express scripts and it seems their prior authorization requirements are stricter than Caremark’s, like I have to have failed Methotrexate in 3 months or have experienced ‘adverse side effects.’ I did try MTX and had terrible side effects but I don’t know if that was properly documented by my last rheumatologist. It seems though that it’s easier to get Express Scripts to approve Enbrel if they see you’re already on Enbrel and experiencing improvement. Have any of you had issues with Express Scripts? Should I just go ahead and stay on CVS Caremark Insurance through Cobra for one more month, get on Enbrel now, and then when I switch to Express I will already be on it so it’s easier to get approval? I just don’t want to end up sabotaging myself if I switch to Express now and then risk the prior authorization being denied. I imagine they will require me to try MTX again but I don’t want to do that and it would just waste time. submitted by /u/OaksJoy9000 [link] [comments]Read Morer/HealthInsurance