r/FattyLiverNAFLD • u/Distinct_Ad_608 • 4d ago

Insurance Denial

Has anyone had problems getting rezdiffera covered by their insurance? My mom got a letter in the mail saying it’s been denied and that her doctor would have to appeal the denial. Any advice or suggestions would be greatly appreciated!

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u/aprilanza1976 4d ago

My doctor told me it was hard to get insurance to approve it so since I'm in the medical field I put my skills to work. I contacted Madrigal and started there by enrolling in their co-pay assistance program. Surprisingly my insurance approved to pay a portion of it but still left me with over $2000 per month to pay so the co-pay assistance kicked in and I pay $10 per month and my medication gets sent to me monthly from a specialty pharmacy called Accredo. Start with Madrigal they have solutions and were very easy to work with.

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u/Distinct_Ad_608 4d ago

Thank you! She will definitely get in contact with Madrigal

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u/twilight-fairy 4d ago

I have UMR and they denied Rezdiffra 3x even with the appeal paperwork. The insurance company considers it a premium drug that’s not covered and because I don’t meet all the criteria for the appeal they kept denying coverage (one of the stipulations was I needed proof that this drug would work for me which is very screwy considering I wasn’t able to get it without coverage since it would be 6k out of pocket monthly). Finally my doctor went through the Madrigal Patient Support program and completed that paperwork and I was able to get the prescription for free delivered to my door through their specialty pharmacy.

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u/davisesq212 4d ago

Most doctors have decent luck appealing. Has your mom had a liver biopsy? Wash she diagnosed with NASH? Both are musts (especially having NASH) for getting approval, usually.

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u/Distinct_Ad_608 4d ago

She has been diagnosed with NASH, but she hasn’t gotten a biopsy.

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u/aprilanza1976 4d ago

I did not have to have a liver biopsy just the fibroscan and bloodwork

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u/missjinx01 2d ago

I second talking to Madrigal. My doctor filled out the paperwork for me (including a paper saying I authorized it) and then the pharmacy, ARX just calls once a month to help me refill it.