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Replies to "@ronludington thank you for the suggestion, but insurance makes me go through all less expensive drugs..."
Polymyalgia Rheumatica (PMR) | Last Active: Jan 21 2:01pm | Replies (21)
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@ronludington thank you for the suggestion, but insurance makes me go through all less expensive drugs before they will approve the more expensive. Also, my Rheumy is only here every 3 to 4 months so it’s going to take a minute to work through.
Terri
Replies to "@ronludington thank you for the suggestion, but insurance makes me go through all less expensive drugs..."
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@rocksology
I'm on a biologic called Actemra (tocilizumab) which is in the same classification as Kevzara. They both work in the same way.
If you have inflammatory arthritis alone or in addition to PMR, it should be easier to get Actemra covered and paid for with original Medicare and a supplement. Actemra can be given as a monthly IV infusion. For some reason it is easier for inflammatory arthritis patients to be approved for a biologic when administered by an IV than it is for PMR patients to be approved for Kevzara as a weekly injection.
It is true that insurance companies want you to try less expensive options first. My rheumatologist didn't exaggerate when he said all other treatment options had failed in my case.
What seemed odd to me is that some people say prednisone is "the only and the best option for PMR." It is no wonder that research into better treatment options for PMR has lagged behind other autoimmune conditions. If patients believe prednisone is the only and best option for PMR then there isn't any need to find another option.
My rheumatologist thought Prednisone for the rest of my life wasn't a good outcome. My rheumatologist stated in the authorization request that "Actemra represented the best chance for me to ever get off Prednisone." It was clear he didn't believe prednisone for the rest of my life was a good option.