Otezla Insurance Coverage Question

My Rheum is suggesting Otezla in addition to the Meloxicam I'm already taking - before moving on to anything else (newly diagnosed, but been living with the pain for 20+ years).

I'm excited to try something new!

I do have a question for anyone who has CA Blue Shield and/or Anthem Blue Cross - any luck or problems getting this approved? Doc indicated it might not be covered?

I have CareFirst and have had a number of their products over the years, as well as Blue Cross of TN. I haven't had any issues getting the specialty meds approved as long as the doc does the legwork for the Prior Authorization before hand. Sometimes the copays are steep, and that's when you contact the maker for a coupon or copay assistance. Another complication is that most insurance companies are now requiring patients go through their specialty pharmacies, so be prepared to go through mail order. Call your insurance company, or go online and look at their formulary. You should be able to find this out with a phone call which should give you some peace of mind. Good luck!

I have Anthem/Blue Cross and take Humira more often than typical (no insurance problem) AND I started on Otelzla, too, about 6 months ago. No problem getting that through either as my doc followed their prior auth procedures correctly. Let me know if you want to talk about Otezla. You should be prepared for some side effects in the first few weeks.

Thanks, everyone! I will keep my fingers crossed!