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Drug coverage

Osteoporosis & Bone Health | Last Active: 15 hours ago | Replies (22)

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Profile picture for janetlee2026 @janetlee2026

I need a medication and it’s not covered. I have the Medicare deductible $2100 and they told me I can break it up monthly. However I did receive in the mail from my insurance Aetna ppo plan that sent me a form to dispute their decision and why it was rejected. Apparently they just needed more information from my doctor as to why this particular drug was needed. I see my doctor in a few days and I’m bringing her the form to fill out and send back in to insurance. The drug is for Actemra (tocilizumab). It sounds like they will allow it with proper medical notes from rheumatologist.

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Replies to "I need a medication and it’s not covered. I have the Medicare deductible $2100 and they..."

Thank you.

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@janetlee2026 Yes, sometimes the problem is not enough information from the doctor (or, more likely, the doctor's assistant.)

@janetlee2026

Is that original Medicare?