@januaryjane

It is always frustrating when the solution to problem is not available due to insurance issues. I have also ran into this situation. I am on Medicare, but some of same rules apply to Medicare as Medicaid. The newest drugs are usually more expensive due to no generic version being available. In my case, I was able to use a GoodRx coupon. I checked for Brexafemme and even with coupon it is over $500. Also, I did a little research on why pharmaceutical companies will not let Medicaid and Medicare patients use their coupons, it is due to the Anti-Kickback Statute from the Social Security Amendments (1972).

I can offer few suggestions:
- Discuss price with provider, sounds like you tried other medications, but let him know Brexafemme is not an option due to cost.
- Appeal the denial. Here is some general information about appealing a health care decision:
-- https://www.cms.gov/cciio/resources/fact-sheets-and-faqs/indexappealinghealthplandecisions
-- https://www.healthcare.gov/appeal-insurance-company-decision/

- Medicaid is administered at state level, so you will have to check with your states Medicaid information about appeal process. It may require your provider to provide documentation on what alterative / cheaper medications you have tried and the fact they did not work and why Brexafemme is needed.

Are you going to continue with current medication instead of Brexafemme?