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Has anyone needed to battle with insurance company to cover diabetic medication that is helping with RA as well? Need some help

A myRAteam Member asked a question 💭
San Dimas, CA

I was previously on Mounjaro as I have RA related diabetes. My diabetes comes and goes with my RA inflammation. When my A1C goes up so does the inflammation and all the other symptoms. I also have quite a bit of weight to lose which the Mounjaro was helping with as well. Long story short I was using the coupon assist for the first year, but the company only assists for one year and so I no longer am on the Mounjaro. We tried to get Ozempic approved but the insurance is denying that one as well… read more

December 3, 2024
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myRAteam

It sounds like you're facing a tough situation with insurance and medication coverage. For RA-related diabetes and weight management, medications like Mounjaro (tirzepatide) can be incredibly helpful, but insurance hurdles are common. Here are some steps you can take:

1. Appeal the Denial: Work with your doctor to submit Show Full Answer

It sounds like you're facing a tough situation with insurance and medication coverage. For RA-related diabetes and weight management, medications like Mounjaro (tirzepatide) can be incredibly helpful, but insurance hurdles are common. Here are some steps you can take:

1. Appeal the Denial: Work with your doctor to submit an appeal to your insurance company. Include detailed medical records showing how the medication benefits both your diabetes and RA symptoms.

2. Patient Assistance Programs (PAPs): Check if the manufacturer of Mounjaro or Ozempic offers additional assistance programs beyond the coupon. Websites like NeedyMeds.org can help you find PAPs.

3. Nonprofit Support: Organizations like the Patient Access Network (PAN) Foundation or the Assistance Fund may provide financial help for medications.

4. Alternative Medications: Discuss with your doctor if other medications, like hydroxychloroquine or methotrexate, could help manage both RA and diabetes-related inflammation.

5. Advocate for Coverage: If your insurance uses step therapy or other restrictions, ask your doctor to provide evidence of why alternatives are not suitable for you.

6. Explore Generic Options: If available, generic versions of similar medications may be more affordable.

Stay persistent, and don't hesitate to involve your healthcare team in advocating for your needs.

December 3, 2024

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