The majority of the work is done between your gasteroenteroligist's office and insurance. Often you/I have little involvement other than making sure everyone has the needed information sent in a timely manner, with good communication. There are times I have had to be the middle man, calling both insurance and doctor and see what the log-jam is, and rectifying it (so being proactive is helpful at times).
My gastero office has a dedicated-nurse who helps patients work with their insurance with the insurance approvals. Its' a complicated process, and she's familiar with the forms and submits them on your/my behalf along with the needed evidence (failed meslamines, are mod/severe, etc etc).
When a medication is new, it may not initially show within the health insurance companies formularies list (these lists are only updated once or sometimes twice a year) and that's okay. There are temporary means of encoding the medications and getting them approved, it is a bit more back-and-forth than older meds that have a streamlined and easy process. A number of posters have said it has been a bit of a hassle for Xeljanz approvals early on thus far, as was the case for Entyvio when it was first approved. But at least you have the 60-day supply now, and can let those knuckleheads work it out without being so worried about
Your best resources are your gasteroenteroligist's office, your health insurance company, and possibly calling Pfizer who makes Xeljanz. I know at least with remicade, there is a dedicated portal and hotline to call and they will assist with approvals and patient copay and deductible reimbursement.
Post Edited (iPoop) : 10/12/2018 8:01:28 AM (GMT-6)