1. < Polymyalgia Rheumatica (PMR)
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Medicare and Kevzara approval 2026

Posted by marci516 @marci516, 2 days ago

Hello, Has anyone on Kevzara and on Medicare successfully had their Kevzara added to the formulary in 2026?
I don't believe any Medicare Rx companies cover Kevzara without the doctor adding it to the formulary/ requesting prior authorization.
I've been on it successfully for at least 18 months.
Last year I had AARP UHC Rx & once the doctor sent in the form it was added immediately. This year my broker had me switch to WellCare and they turned it down after my doctor sent in all necessary documentation. I'm wondering if it's the company or if it is more difficult this year.
I have been on Prednisone & failed terribly. My doctor is attempting to continue the fight.
Thank you

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stonewheel | @stonewheel | 21 hours ago
In reply to @tweetypie13 "I had no problem….my RX supplemental United Healthcare has not chged . My Rehumy practice has..." + (show)
Profile picture for tweetypie13 @tweetypie13

I had no problem….my RX supplemental United Healthcare has not chged . My Rehumy practice has a pharmacy in it.

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@tweetypie13 that’s who I have. I just 40 minutes got a call from them approving Kevzara for me.
Anxious for a new page in this PMA chapter of my life.

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tweetypie13 | @tweetypie13 | 20 hours ago
In reply to @stonewheel "@tweetypie13 that’s who I have. I just 40 minutes got a call from them approving Kevzara..." + (show)
Profile picture for stonewheel @stonewheel

@tweetypie13 that’s who I have. I just 40 minutes got a call from them approving Kevzara for me.
Anxious for a new page in this PMA chapter of my life.

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@stonewheel
GREAT NEWS!!!!!!!
dancing in the streets for you!

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tweetypie13 | @tweetypie13 | 20 hours ago
In reply to @laurelfagan "@susanlf I am on WellCare too and I have to reach my $2100 cap this year..." + (show)
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@susanlf I am on WellCare too and I have to reach my $2100 cap this year then Kevzara is zero copay.

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@laurelfagan
My first month of a Kevzara is $2000.00+ . You will have deductible covered in no time

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marci516 | @marci516 | 12 hours ago
In reply to @ropnrose "@marci516 Good luck. Keep us posted on your status with WellCare and if you're successful. It..." + (show)
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@marci516 Good luck. Keep us posted on your status with WellCare and if you're successful. It shouldn't have to be a battle. My rheumy wanted me to take Kevzara last year, but I had WellCare and knew it could be a fight to get it approved. I was having a flare of PMR/GCA and didn't need the stress. Fortunately, my rheumy put me on Actemra infusions, since I had a history of GCA. Didn't have to deal with WellCare, since my Medicare covered it.

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@ropnrose glad to hear you’re doing well on Actmera. I had no struggle getting approval with UHC last year. My doctor & specialty pharmacy are still fighting for me. The stress is definitely showing in my pain. Thanks, I’ll keep you posted.

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