Good question, and doctors are pros at getting appeals approved. Like @bayarea58 stated Arikayce can be a PITA for some, however it's been an easy antibiotic for me-zero side effects. Here's what my Mayo doc sent me back in July:
Terri, You're still testing positive for MAI after 4 months on the three multidrug treatment, so I strongly recommended adding Arikayce once daily. You will stay on all treatment for at least 18-24 months after sputum testing is negative. This helps make sure
the MAI bacteria are cleared from your lungs.

So, see if your doc would send in scans, results, and notes for approval in order to get coverage for Arikayce. It's very expensive without insurance, however some people choose to pay out of pocket for it since it's a GREAT drug to convert to negative. But be aware that it'll be tough without sputum samples for evidence of bacteria. And, how will you know when you do convert? Keep us in the loop and wishes for good health, Terri