Benlysta Preauthorization Denied; Pain Meds That Help Lupus?

That’s terrific! We trust so much in our rheumatologists. I have an amazing young woman who gives me my care. She listens! I trust her so much.
So glad you’ll be trying the new med!!! Please post how you do??? We need a success story!!! Best Always

Good morning! I was diagnosed with Lupus three years ago. I have been on Plaquenil ever since. I can tell you that at the end of 2024 I had to come off of all me meds for a bone marrow biopsy because I had to had surgery and my bloodwork was so bad that I had to postpone surgery. Anywho, after two weeks of not taking the Plaquenil, I could tell that I had not been on it because all my pain came back but worse. I ended up on prednisone for a couple weeks until I was regulating again. With that being said, my arthritis was still bad so my Rheumatologist recommended Benlysta in conjunction with the Plaquenil. Even with commercial insurance I still could not afford the co-payment. There are a couple programs out there that have $0 or $5 co-pays with saved me. I can say that the Benlysta was God sent 😊 my arthritis joint pain is 80% better than what I was dealing with prior to the Benlysta. Unfortunately, I am turning 65 in June and going into Medicare. Now I’m dealing with how to get Benlysta covered by Medicare. I know there are work arounds for that, so I’m just thankful that I will be able to continue this regiment with both the Plaquenil and Benlysta. Good luck to everyone dealing with any kind of autoimmune diseases. God Bless!!!

Regarding Insurance denial - I, too, had been denied insurance on an infusion product, prescribed by my Dr., for a very good reason! The Insurance companies have the upper hand, seemingly, these days! I was told that I was to try another medicine, ordered by the Insurance Company, first! This infusion medicine that the Insurance Company wanted me to have ordered, by my Dr. is designed for home care, where the patient has learned how to set up their own i-V infusion, and do it all themselves! If I was younger and able to do that, I might have tried! However, I have had long standing Parkinson’s Disease, for a number of years, where I have a tremor in my hands, both rolling pill tremor, and essential tremor! Additionally, I have had Carpal Tunnel syndrome, from assembly work, from many years ago! Additionally, I have been diagnosed with polyneuropathy, which affects both hands and feet. So, there was a reason why my immunologist prescribed infusion I-V therapy, in a clinic, nurse administered setting! This insurance Company denied approving my receiving infusion within a clinical setting! I appealed, and eventually got insurance coversge elsewhere! The Mayo Clinic analysis and diagnosis of my immune deficiency rare disease condition, and my immunologist’s prescription orders, were eventually recognized by Medicare and a different Supplemental Insurance Company, so that the costs will be covered, and I just recently started infusion I-V therapy, with a needed, very expensive product, after a several months delay, due to the Insurance debacle! I truly needed the infusions A.S.A.P. when first ordered, becsuse my condition was deteriorating! So, I suffered physically, for several months, because of this Insurance denial! Thankfully, I’m starting to feel better now! This last year, I’ve had several Insurance problems, where coverage and treatment of my serious, diagnosed, medical problems, were delayed, because of Administrative changes, by Insurance providers, where coverage was denied! I’m nearly 80 now, and in my entire lifetime, I have never before had to deal with these types of denials, and delays, concerning treatments and coverages, of important, diagnosed, illnesses!!

@foundryrat743 - Oh my goodness!! I'm so sorry you've encountered these hassles and delays, but more importantly, pain while you waited. Thank goodness you persevered and are now receiving the therapy and seeing results. Wishing you continued improvement and relief from all the conditions you're facing!

@sarahintexas I appreciate your reply! You are very supportive. The last few months have been very difficult for me, because I was diagnosed with 3 difficult disorders, all requiring important treatments, that required approval from Medicare, and my Supplemental Insurance! I had great difficulty and delays getting approvals in all cases, which, in my opinion, should never have happened! MRI results and lab. results from Mayo Clinic, proved, beyond reasonable doubt, that I had some serious disorders thst required medical intervention ASAP! In my nearly 80 years, I repeat, I’ve never had to go through this delay of treatment and coverage, like this! It would be different if I was on welfare, and had no money to pay, but each month, I pay a total of $520.00 for Medicare insurance coverage and Supplemental care coverage! Something is horribly wrong with the Insurance coverage system for seniors, these days! When my Grandparents got old and feeble, and needed medical care, I recall that they were attended to and had covered insurance, on a timely basis, where they did not suffer, being in discomfort, having to wait months for an approval! I’ve had to go through appeals etc., where I have never, ever had these type problems before! I hope you don’t have to encounter delays, in your approvals and treatments! Thanks again, for being so supportive!