1. < Polymyalgia Rheumatica (PMR)
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Medicare and Kevzara approval 2026

Posted by marci516 @marci516, 1 day ago

Hello, Has anyone on Kevzara and on Medicare successfully had their Kevzara added to the formulary in 2026?
I don't believe any Medicare Rx companies cover Kevzara without the doctor adding it to the formulary/ requesting prior authorization.
I've been on it successfully for at least 18 months.
Last year I had AARP UHC Rx & once the doctor sent in the form it was added immediately. This year my broker had me switch to WellCare and they turned it down after my doctor sent in all necessary documentation. I'm wondering if it's the company or if it is more difficult this year.
I have been on Prednisone & failed terribly. My doctor is attempting to continue the fight.
Thank you

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marci516 | @marci516 | 3 hours ago
In reply to @susanlf "I was on Kevzara for 2 months until it tanked my white blood count. I went..." + (show)
Profile picture for susanlf @susanlf

I was on Kevzara for 2 months until it tanked my white blood count. I went through CVS Specialty Pharmacy and was approved for a 2-pack $50.00 payment, instead of the over the counter $3,000 that was quoted by the retailer CVS. Keep trying and you’ll find something that works!

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@susanlf too bad it didn’t work for you. I hope your WBC is back to normal & they found something to help your PMR. I go through a specialty pharmacy where my doctor is. Very interesting about CVS. Right now my issue is the insurance company. Thank you

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marci516 | @marci516 | 3 hours ago
In reply to @ropnrose "@marci516 Look into the 'birthday rule' for Medicare. You can change your supplemental, outside of the..." + (show)
Profile picture for ropnrose @ropnrose

@marci516 Look into the 'birthday rule' for Medicare. You can change your supplemental, outside of the enrollment period. Each state has it's own rules.

Those of you talking about the UHC premium, isn't that your supplemental? It shouldn't impact your Part D. I have UHC supplemental and WellCare for my Part D. They don't impact each other.

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@ropnrose my supplemental is & was AARP UHC. I switched to WellCare for my part D. You’re correct they don’t impact each other. I will keep fighting this battle tomorrow. Thank you

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tweetypie13 | @tweetypie13 | 2 hours ago
In reply to @susanlf "I was on Kevzara for 2 months until it tanked my white blood count. I went..." + (show)
Profile picture for susanlf @susanlf

I was on Kevzara for 2 months until it tanked my white blood count. I went through CVS Specialty Pharmacy and was approved for a 2-pack $50.00 payment, instead of the over the counter $3,000 that was quoted by the retailer CVS. Keep trying and you’ll find something that works!

Jump to this post

@susanlf
When my WBC tanked, we spaced my Kevzara shots to 3 wks and who came back and no problems with the Kevzara spacing.

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tweetypie13 | @tweetypie13 | 2 hours ago

Also, Kevzara has some financial offers on their website.

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