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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

    Mar 26, 2010
    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

    Aug 28, 2011
    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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