Cosentyx Insurance Denial

Page Contents:

• What is Cosentyx?
• Who Needs Cosentyx?
• Why Do Insurance Companies Deny Cosentyx?
• What Are Your Legal Rights to Cosentyx?
• How The Law Offices of Scott Glovsky Represents Cosentyx Insurance Denials

Cosentyx is a biologic medication that was approved for the treatment of psoriasis in 2015 and for the treatment of psoriatic arthritis in 2016. Cosentyx (generic name Secukinumab) works by blocking an inflammatory protein called IL-17. IL-17 is a cytokine that produces autoreactive T-cells that play a major role in autoimmune diseases.  By blocking this protein, Cosentyx decreases joint pain and swelling from arthritis, along with the rashes seen in those with plaque psoriasis.

Cosentyx is also used for patients who have ankylosing spondylitis—an inflammatory arthritis that affects the spine and large joints.  Cosentyx has been extensively studied for more than a dozen years, with many clinical trials attesting to its efficacy. A Cosentyx insurance denial can wreak havoc on the health of an individual who has benefited from the drug and requires a strong insurance denial attorney to deal with the situation decisively.

If you suffer from psoriatic arthritis, plaque psoriasis, or ankylosing spondylitis, your doctor may have prescribed Cosentyx. Plaque psoriasis can cause serious rashes, thickening, peeling, fissures on the skin, along with joint paint. Ankylosing spondylitis causes pain and stiffness in the joints, lower back, middle back, neck, shoulder, and ankles, and can also inflame the eyes. The condition can also cause fatigue, IBS, physical deformity, and sleep disorders. Psoriatic arthritis also causes stiffness and swelling in the joints or back, skin rashes, fatigue, or inflamed fingers or toes. All of these symptoms are serious and can significantly interfere with your quality of life. Cosentyx can help alleviate these symptoms, allowing you to get back to your normal activities.

The list price for Cosentyx is $6,471 per month for 150-300 mg strength or $3,235 per month for 75 mg. strength. The most common reason insurers deny coverage is that other therapies were not tried prior to requesting a biologic. Other reasons for a denial of Cosentyx include how the insurer has tiered biologics or the increased number of insurance requirements listed in authorization forms. Of course, the ultimate reason most prescription drugs are denied lies in the cost of the drug. If you’ve received a Cosentyx insurance denial, it is imperative that you secure solid legal assistance from attorney Scott Glovsky.  

If you’ve been denied Cosentyx, you may be unsure of your legal rights. It’s important to remember that you can appeal your Cosentyx insurance denial. This is true whether the prescription is not on your insurer’s formulary, your insurer does not believe Cosentyx is medically necessary, or your insurer wants you to try a more affordable treatment first. Once your insurer has provided you with a written Cosentyx insurance denial, you can appeal the decision. Your healthcare provider may need to provide a letter that details why you need Cosentyx and if this is insufficient, it is time to speak to attorney Scott Glovsky regarding your denial.

If your insurance company has denied Cosentyx, a Los Angeles prescription drug denial lawyer from the Law Offices of Scott Glovsky can make a real difference in the outcome. We will ensure your insurance carrier fully honors its contract with you and that you receive the prescription drugs your doctor prescribes. Contact the Law Offices of Scott Glovsky today.