RA Medication and Insurance Coverage on Medicare with a Supplement

My daughter has been diagnosed over a year with rheumatoid arthritis. So far she has refused to take any medications. I worry about the progress of theRA

@tubbyfalcon67

I would worry too. RA attacks the joints AND organs. We are convinced (both from our research and a discussion with a Mayo Rheumatologist) it has created problems with her heart and liver.

Check with the company that makes the medication your wife needs. Some companies offer a program to help patients who are not covered or don’t have medical insurance. I did that many years ago and I end up getting my medication for free, but every company is different.
Make sure you get to the company’s homepage and not some other company trying to sell you something
I wish you the very best

@tubbyfalcon67,
sometimes patients don't realize how debilitating the pain can become. There is a therapist at a pain clinic here that can barely use his hands the the fingers are so twisted. He is in constant back pain because RA attacked his vertebral joints. He tells that he was diagnosed early in Mexica and prescribed methotrexate, but wasn't in pain and didn't take the medication. Once his hands because painful he was diagnosed again in the US. He took medication for a while, but didn't trust the medical system and soon quit. Now pain, pain medication, and disability are his constant companions. He's a study in regret.
I hope your daughter will feel the danger in time to prevent major damage.
You probably can't tell her anything. Maybe if she saw images of the way RA destroys the bone. https://www.google.com/search

@minnesota10

Thanks for your help. When the doctors come back with the final suggestion for the medication and they check with the insurance company for coverage, I will take your suggestion as the next step.

Rx company coupons are not available if you are on Medicare, Medicaid, etc.

@bens1 Step One is to look at the drug formulary for your Medicare Supplement to see which drugs are covered, whether prior approval is required, and whether "step therapy" (cheaper options failing) is a prerequisite. If you don't know where to find your specific formulary, call the number on your insurance (not Medicare) card and ask.

Once you know the rules for your policy, work with the doctor to initiate the prior approval. Also ask if the least-restricted med might work for your wife. They probably have dedicated staff to navigate the prior approval process, and they are really good at it.

Initial denials are common, and the reasons given quite specific. If you receive one, call the doctor's office immediately, and have them appeal. Appeals must be handled within a certain number of days, and sometimes a second-level appeal directly to Medicare is required.

I know this is frustrating, but it is one of the ways companies are trying to keep costs down.

@azgerbil03 Welcome to Mayo Clinic Connect! You can see that this is a forum for members to ask questions and get answers about their health journey.
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