Xeljanz Insurance Denial

Page Contents:

• What is Xeljanz?
• Who Needs Xeljanz?
• Why Do Insurance Companies Deny Xeljanz?
• What Are Your Legal Rights to Xeljanz?
• How Can the Law Offices of Scott Glovsky Represent Clients Who Are Denied Xeljanz?

What is Xeljanz?

Xeljanz (Tofacitinib) is a Janus kinase inhibitor (JAK). Those who suffer from rheumatoid arthritis or psoriatic arthritis could get relief from a JAK inhibitor that lessens inflammation and pain by decreasing an overactive immune system. By decreasing an overactive immune system, damage to the joints can also be prevented. Xeljanz can be used alone or in conjunction with methotrexate.

Xeljanz is both a JAK inhibitor and is classified as a Disease-Modifying Anti-Rheumatic Drug (DMARD) as well. The drug is not considered a true biologic—although it is similar in nature to a biologic—because it is made through traditional drug manufacturing techniques.

A biologic, on the other hand, contains human-made proteins from a living source or the products of a living source. If you’ve received a Xeljanz insurance denial, you may be unsure of what you need to do next. Speaking to an experienced Xeljanz insurance denial lawyer can be your best course of action.

Who Needs Xeljanz?

Those whose arthritis is active and who have not tried other treatments appropriate for psoriatic arthritis or rheumatoid arthritis could potentially benefit from Xeljanz. Patients with moderately to severely active ulcerative colitis who are intolerant to TNF blockers could benefit from taking Xeljanz as could juvenile patients who suffer from juvenile idiopathic arthritis (if they have been shown to be intolerant to or had an inadequate response to TNF blockers). Blood tests are always done prior to prescribing Xeljanz to determine whether the drug is suitable for the individual patient. Those who are taking Xeljanz are also monitored while taking Xeljanz to ensure red and white blood cell counts remain normal.

Why Do Insurance Companies Deny Xeljanz?

Xeljanz can cost as much as $5,487 per month, which can cause insurance companies to deny the drug. The insurer may claim that Xeljanz is “experimental,” although it gained FDA approval in 2012 to treat adult RA patients, in 2017 to treat patients with psoriatic arthritis, and in 2018 to treat ulcerative colitis. According to NCBI, about 55.6 patients who appealed the decision not to cover Xeljanz were later approved for the drug after this first appeal. Another 5.6 percent were approved following the second appeal. These statistics were from 2019, so your odds of being approved for the drug following a prescription drug insurance denial—particularly when an attorney is part of the equation—are high.

What Are Your Legal Rights to Xeljanz?

If your insurance company has refused to pay for your doctor-prescribed Xeljanz, you do have legal rights and options. If the drug is not on your insurance plan’s formulary, you can ask your doctor to request an exception based on medical necessity. If the insurance company still refuses to pay for the drug, you can file a formal, written appeal. When you reach the stage where an appeal is necessary, you can significantly benefit from speaking to a knowledgeable insurance denial attorney from the Law Offices of Scott Glovsky.

How Can the Law Offices of Scott Glovsky Represent Clients Who Are Denied Xeljanz?

While the world we live in tends to favor big businesses and major corporations over the average person, Scott Glovsky fights this fight daily, making a real difference in his clients’ lives. Scott’s goal is to change the system one case at a time to prevent his clients as well as others from suffering bad decisions by insurers. Contact Scott Glovsky today for help obtaining the drug you need for your health and your future.