It's just going to be a fight because it is not on their yearly formularies because it was recently approved by the FDA for UC in June.
You've got a good case that should be winnable with a good insurance plan. You have two things going for you, currently have the medicine and you are responding to it.
This will take a little bit of effort by your GI's office but it is definitely something that you should be able to win; it make take two appeals and your GI making a phone call.
Xeljanz is not that expensive compared to other medications. I was given Stelara prior to it being approved for CD. They did it as an offlable approval since it was not approved for CD at the time. My insurance company is billed $43K a dose.....again, Xeljanz is already approved by the FDA.
Ask your GI's office for guidance about
insurance policies and Xeljanz.
DX'd with Severe Pancolitis June 2005
Previous Meds: 5ASAs, Predisone, 6-MP. Remicade, Humira, Simponi, Cimzia & Cyclosporine
3-step J-Pouch surgery: 2013 & 2014
Current Condition: Chronic Pouchitis -- Not as bad as I thought it would be
Current Meds: Stelara
Total Hip Replacement: 12/16 -- Thanks Prednisone!!!www.healingwell.com/community/default.aspx?f=38&m=3755226