Medicare Part D - Prior Authorization

[RoBo]

I am in my second year of Medicare. I have one drug not listed on any Part D provider's list- Otezla. My MD will fight for me to get the prior approval. If I cannot get a prior authorization approved I would have to pay $48,000/yr for that drug alone! None of the providers will tell me in advance whether they will approve the drug for prior authorization.

Is anyone able to give me feedback as to which providers are more or less liberal in giving such a prior authorization?

 

[njhowie]

Personally, I would not sign up with any provider if they could not give me coverage info for an expensive drug I needed. I'm assuming there is no other alternative drug which will suffice.

On Otezla's website it indicates:

Covered by Medicare or Medicaid

If you’re covered by Medicare or Medicaid, give Otezla SupportPlus a call at 1-844-4OTEZLA. Our team can talk to you about independent co-pay foundations and state programs that may be able to help you pay for your prescription.