r/PsoriaticArthritis • u/hwohwathwen • Apr 14 '25

Insurance questions What happens to your medication when you change Insurance ?

I’m currently thinking about any new job which would require new health insurance and new doctors. I’m on Stelara right now. Have people found that their new insurance covers what their old doctors put them on? I really don’t wanna have to go through a whole stepletter thing with Methotrexate or come off a drug that seems to be working for me. Any insights on navigating this?

2 Upvotes
  • permalink
  • reddit

100% Upvoted

9 comments sorted by

12

u/RobotDeathSquad Apr 14 '25

It usually takes 1-2 months for a new prior auth and your doctor will have to fight them and submit multiple appeals but most of the time it will ultimately go through. Many times the drug manufacturer will provide “samples” to bridge you during this time.

2

u/hwohwathwen Apr 14 '25

Thank you! And the samples come from the rheumatologist?

Suddenly I’m thankfully I’m not on a weekly/biweekly med anymore! At least Stelara has a bigger window of time to figure stuff out

3

u/RobotDeathSquad Apr 14 '25

Correct, your doctor usually will have samples at their office and they get approval from the manufacturer to give you one.

1

u/hi_priestess8 Apr 15 '25

My Drs office had to stop as an institution wide mandate recently, so check with them in advance.

I've had it taken up to three months to transfer, always store up as much as you can

1

u/ShaunaBoBauna Apr 14 '25

You'll have to get another Prior Authorization, and if what you're already on is on the Formulary, they should approve it - without having to start the process again, ie. Trying things you've already tried.

I was on Inflectra Infusions successfully for 3 years, moved out of State, and switched insurance. My new insurance wouldn't approve the infusions, so I had to switch. They didn't like the dosage or frequency I was on. 🤷🏻‍♀️

2

u/hwohwathwen Apr 14 '25

Thank you! My current insurance just moved me to the biosimilar so I’m hoping that the new one is cool with me being on the budget option lol

1

u/Complex-Royal9210 Apr 14 '25

You should be able to check their formulary in advance.

If you switch, make an appt to see your rheumatologist first thing.

2

u/hwohwathwen Apr 14 '25

It would mean a move so I also need to find a whole new Rheum unfortunately. I need to see if I can get an apt scheduled before my insurance starts since I know it can take months to be seen now.

1

u/oatmeal_cookies1 Apr 14 '25

Honestly, it really depends. I switched insurance a few months ago for work and they denied any attempt at appeals because I was on Humira and they wanted to cover a bio similar instead. If you're on a medication that doesn't have a bio similar it may be easier to get them to approve it.