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Apidra approved by Express Scripts for me

Discussion in 'General Discussion' started by redheadmom, Feb 10, 2014.

  1. redheadmom

    redheadmom Approved members

    Joined:
    Mar 26, 2010
    Messages:
    104
    I don't know if someone has already posted about this same sort of situation, but I wanted to let people know that even if Express Scripts says you can't have coverage for Apidra, you may still be able to get approval for it.

    Here's what I did:
    -I called Express Scripts and asked for a Benefit Coverage Request Form, which they snail-mailed to me.
    -I asked my doctor to mail me a statement of medical necessity. (He stated that I had tried Humalog and that it was too slow to act on my high's and had too long of a "tail", causing lows hours after a bolus.)
    -I filled out the form and mailed it to Express Scripts along with my doctor's statement.
    -I received a call from Express Scripts less than a week later approving my request.
    -Today I filled an Apidra prescription to verify that the coverage was working, and it was approved!

    So appealing is really worth a try! I am SO glad because I really do better with Apidra and did not want to switch.
     
  2. MomofSweetOne

    MomofSweetOne Approved members

    Joined:
    Aug 28, 2011
    Messages:
    2,739
    Our doctor appealed for the test strips we'd been using as well. We'll be paying a bit higher copay, but it is so worth it to us to have consistent readings again.
     

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