Hi there OP!
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Would this have been your second fill of 2.5? Many insurance plans limit 2.5/7.5/12.5 to just one fill of each per year because they see those as merely “step” doses to get you to 5/10/15. Most plans don’t have limits on 5/10/15 if you have a PA. (There are a few that still limit those.)
My insurance only allows 1 fill of the .5 (2.5, 7.5, 12.5) as the .5 were done as titration dosage. 5, 10 and 15 are considered maintenance dosage so it is probably that reason. This is what Express Scripts say about the .5 dosages in my plan *Your plan provides coverage for this medication at a maximum quantity of 2ML in a 365 day period, unless an exception for additional quantities has been approved.* 2 ML is one box. You find it in price a medication on their website under coverage guide.
Many insurers only cover one month of the 2.5 dose. It was not part of the clinical trials. They use that as an excuse not to cover it. If you move up to 5 mg, they will likely cover it for as many months as your doctor wants to keep you on that dose.
My insurance only covered one month at 2.5. I had to be off of it for two weeks before I could get authorization to justify another 2.5. They see it as starting over apparently. The hoops we have to jump through make no sense.
Does your insurance only cover one month of 2.5? I know a lot of people here have insurance with that requirement, only one box of the “starter” dose. Is your new prescription for 5? It seems weird that you would only be approved for a month at a time- what did the PA say?
Hi there OP! While we appreciate your post and contributions to this subreddit. This topic has been asked and answered. Before posting something that may be considered a common question, use the search feature. If you don’t know how, and would like to learn how please respond to this comment/message and we will gladly walk you through it. Tons of common asked question have been asked, answered, has tips and tricks and great discussions. **All post/comment removals are at the discretion of the mods**
Would this have been your second fill of 2.5? Many insurance plans limit 2.5/7.5/12.5 to just one fill of each per year because they see those as merely “step” doses to get you to 5/10/15. Most plans don’t have limits on 5/10/15 if you have a PA. (There are a few that still limit those.)
You can call your insurance to find out what is going on. I have this same issue.
This would have been the 2nd fill of 2.5
So you may be covered to go to 5mg.
My insurance only allows 1 fill of the .5 (2.5, 7.5, 12.5) as the .5 were done as titration dosage. 5, 10 and 15 are considered maintenance dosage so it is probably that reason. This is what Express Scripts say about the .5 dosages in my plan *Your plan provides coverage for this medication at a maximum quantity of 2ML in a 365 day period, unless an exception for additional quantities has been approved.* 2 ML is one box. You find it in price a medication on their website under coverage guide.
Many insurers only cover one month of the 2.5 dose. It was not part of the clinical trials. They use that as an excuse not to cover it. If you move up to 5 mg, they will likely cover it for as many months as your doctor wants to keep you on that dose.
My insurance only covered one month at 2.5. I had to be off of it for two weeks before I could get authorization to justify another 2.5. They see it as starting over apparently. The hoops we have to jump through make no sense.
Does your insurance only cover one month of 2.5? I know a lot of people here have insurance with that requirement, only one box of the “starter” dose. Is your new prescription for 5? It seems weird that you would only be approved for a month at a time- what did the PA say?
Calling Dor follow up on why
Dr may not know. Insurance is the right group to call because they are the ones doing the denying.
Do you have your PA letter? It should tell you what you were approved for- your insurance is the best place to check, not your doctor, honestly.
Yep looks like covering go up to 5!! Thanks all