Kevzara insurance denial options

The most effective medications would probably be Actemra or Tyenne. Those are not approved for PMR in the US, but sometimes they are allowed in cases where prednisone isn't effective. If your insurance isn't approving Kevzara, I don't know if they would approve one of those, since they are biologic drugs like Kevzara.

Methotrexate is used a lot for PMR. It works well for some people, but the side effects bother others. I've seen leflunomide mentioned as a treatment, but I don't know anything about it.

You should be aware that Actemra/Tyenne and methotrexate can take up to 3 months to take full effect. If you stop taking prednisone on February 20th, you might be at risk of a flare before the new medication takes effect.

Another thought - have you looked into financial assistance to buy Kevzara yourself? Depending on your income, there are some programs that provide financial assistance.

@jeff97
Thank you so much for your input! Just today I was approved to continue on Kevzara. It took some persistence but it was worth not having to start something new. I had some good people working on it. And I will be so grateful to toss the prednisone!!😊

@caroljeand
Call Sanofi, the co- makers and marketers of Kevzara at
844-KEVZARA .
Sanofi has a department that assists with, and sometimes provides full coverage of Kevzara.

Lets us know how you do with them.

@stonewheel
It is accomplished. Thank you!
The problem initially was getting my insurance to approve the medication since it’s not on their formulary.
Then I had to show that I had signed up for the prescription monthly payment program.
So it took some patience but in the end I’m finally approved for this year.

@caroljeand That's great that you got approved to stay on Kevzara. That's the best medication for PMR, and you're already up to full strength on it.

My rheumatologist works with some specialty pharmacies that don't fill prescriptions. All they do is work with insurance companies to get pre-approvals for medications like Kevzara and Actemra. Once the medication is approved, a different specialty pharmacy fills the prescription.

@jeff97
I’m hoping kevzara is a safe alternative to prednisone as it is still a new medication and as all medications go, we don’t know the full extent of all the side effects. I’ll put my faith in it for now and hope I escape this disease permanently!

@caroljeand I've been taking weekly Actemra injections for a year and a half. Actemra and Kevzara both work in the same way. The only side effect I have had from Actemra is some minor fatigue after the first few shots. I had a lot more side effects with prednisone.

@jeff97 I am just the opposite. I have had no real side effects from prednisone. Been on it since 2011. I was on Kevzara for 9-0 months. I had too many infections and low white blood counts. So I was out back on prednisone.

@caroljeand The lesson learned here should be that your drug coverage will tell you what it takes to be approved - it is not a game of guessing why the denial you simply need to see the written denial (online or in the mail) than call and ask questions if you don't understand. I was recently denied - the problem was my insurance did not advise me online - they sent a letter advising me so it took a week before I found out. In my case it was a coding error on the part of my doctor's office.

So when does one get on Kevzara? What is the point at which a Dr will prescribe it? Length on prednisone? Pain levels? I started pred end of March,2025. The drop downs were very easy until I hit at 4 w/a little pain I chose to deal with but I continued my drop downs till I hit 3mg/alternating days 2.5 mg. Well Pains were coming back a bit stronger. Rheumy says to bump back to 4 mg till I See him in early April.