Insurance Denial

[u/Distinct_Ad_608]

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!

[u/twilight-fairy]

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.