@picartist Oh, I wasn't ever denied. I was approve,d . I'm sure you have to be approved for this to count toward your part D out of pocket cap which is why this can be affordable. My pulmonologist got me approved through Medicare. I suppose she had to fill out a questionnaire about my multiple exacerbations and 2 hospitalizations, so there was probably no contest about approval. The only question remaining, was whether I would get a grant to help with that first big co-pay. That's all the grant does, I believe, at least for Medicare recipients. Maybe the grant does more subsidy for younger people, IDK. The specialty pharmacy dealt with my insurance. I have a very low monthly Part D premium (under $5 a month). Boy I was shocked. But I had to pay that first month co pay of $2000, while Humana paid over $5000. This one-time co-pay (basically the entire annual Part D out-of-pocket-cost cap) moved me into stage 3 (Catastrophic) coverage, which means I have no charges for the remainder of the year, on ANY of my drugs - amazing, because a couple of my other drugs aren't cheap either. But at over $7000 a month, who in the world can just buy Brinsupri? Maybe because of that part D cap, Medicare patients are getting approved, whereas younger people on private insurance have a higher chance of denial. I don't know why anyone would be denied, if there is documentation showing the need.