Kevzara not being covered next year?

I'm on straight Medicare and not an Advantage Plan but I had a similar issue losing my coverage for Kevzara when the drug company's patient assistance program kicked me off at the end of last year. My part D drug plan would not cover Kevzara. You could try to get on their program called Kevzara Connect or just get some advice from them. I ended up on Actemra infusions which are covered by Medicare with a GCA diagnosis. My primary diagnosis is PMR but I have some GCA symptoms so my doctor coded it "giant cell arteritis syndrome" and the infusions are covered. Some people on this list have gotten Actemra covered for PMR so it might be worth looking into.

My UCare advantage plan is going away this year. I have signed up with BCBS Minnesota for 2026. My insurance broker told me that Kevzara is not covered even if I bought the more expensive plan.

I have been on Actemra for over a year for GCA. I am on a Medicare Advantage plan in CT. All my plan options have taken Actemra off their formularies, my Dr said she will ask for an exception due to my disease, I’m guessing that will be denied. Anyone else having this problem? Now that there is a $2,000 cap on specialty drugs, these plans have dropped them, they do not want to absorb the costs.

@dbyrne I'm having the same problem with Kevzara. My Rheumatologist wants me to switch to methyltrexate (sp). But the Kevzara has been helping so I'm hesitant to change.

@kpoesch
How long have you been on kevzara. I just took my first injection this week. Wondering how long it took for good results.

I have to purchase my blood pressure med from Canada because I must take brand, and no one covers brand. The generic causes my BP tp go into stroke territory. My allergist says it's a reaction to the compounding agents in the generic, not a reaction to the drug itself. I also purchase my hyaluronic acid injectables for my shoulder injections in Canada since the US is the only country in the world that does not approve of hyaluronic acid for shoulders, thus no insurance in the US covers it. Google "drugs from Canada" - and start at a site published by the Canadian government that explains how it works and how to find "approved" companies. I save about $3,500 on my BP drug and $1,500 on my injectables each year. You must get an Rx from your local doctor and fax it to Canada. Then a Canadian doctor writes an Rx valid in Canada - and then you can order the drug from the selected Canadian location.

@caroljeand I've been on it for 6 mos. Am still tapering prednisone at 3/2 mg. Noticed a difference at about 3 mos. But every day is different. I'm taking physical therapy a couple of times a week now so that makes a difference too.

My rheumatologist had to get an exception to get it on my humana formulay this year. She will have to do it again for next year . I'm hoping that will go through. And hopfully my novant specialty pharmacy will remain in network.

I was just perusing my Medicare plan D choices. It seems none of them cover Kezvara!! I’m in the Midwest. Not sure if locations matter but there’s no way in hell I’m paying the tens of thousands $$. Gotta hope my lowering prednisone & methotrexate work for me in 2026.

@kpoesch
Hi there. I have been on Kevzara fro 6 months and r still on 32 mg of Prednisone! I am not sure what your message reading 3/2 meant. I ask as I am on Kevzara and am having trouble tapering. Thank u for sharing.