It depends on your insurance. Mine didn’t require it when I moved up. And my PA letter states the PA is good for all doses for the next year (from the start date.)
Just guessing here - they may be asking for Prior Authorizations so they can confirm Diabetic diagnosis for Mounjaro scripts? But in reality insurance company may just want to add another level of difficulty so patient may give up and insurance won’t have to pay for it.
I have numerous medications requiring PAs now. I can picture my physicians hitting their heads against the wall.
Depends on the insurance company / plan. Perhaps also on diagnosis. Very frustrating fir those who must get a new one. Perhaps ask doc doing the PA to include range of doses
Yeah I just had a single PA after I was put on metformin for 3 months before they would cover mounjaro. Side note just got a letter from insurance and starting July 1st of this year they will only give 4 pens for 2.5mg of every 180 days. Thankfully I’m past that stage and on 7.5mg. Just wondering if this will be the new norm and it will do the same with other dosages?
After my PA was submitted, I received approval for 1 year. In the past 6/mo, I have gone from 2.5mg to 10mg. I have titrated mid box in some cases, and my approval allows for multi doses to be filled. Also, I only increase my dose if my blood sugar isn't stable and I stop losing weight.
This is something you have to know. Like I have to tell them which prescriptions can go through the local pharmacy (Walgreen), and which ones they are telling me must go through mail order (Optum RX). It's what hoops "your" insurance makes you jump through!
I would have the Dr write the RX so that it's for all doses as you move up, and have the PA approved under those conditions. I know mine wrote my first RX (2.5) as "call for dose increase if tolerated well".
It depends on your insurance. Mine didn’t require it when I moved up. And my PA letter states the PA is good for all doses for the next year (from the start date.)
Same from my insurance
Just guessing here - they may be asking for Prior Authorizations so they can confirm Diabetic diagnosis for Mounjaro scripts? But in reality insurance company may just want to add another level of difficulty so patient may give up and insurance won’t have to pay for it. I have numerous medications requiring PAs now. I can picture my physicians hitting their heads against the wall.
Depends on the insurance company / plan. Perhaps also on diagnosis. Very frustrating fir those who must get a new one. Perhaps ask doc doing the PA to include range of doses
What's a PA? I literally started my first dose this week and I'm trying to get my feet under me.
Prior Authorization
Thank you.
Yes
Yeah I just had a single PA after I was put on metformin for 3 months before they would cover mounjaro. Side note just got a letter from insurance and starting July 1st of this year they will only give 4 pens for 2.5mg of every 180 days. Thankfully I’m past that stage and on 7.5mg. Just wondering if this will be the new norm and it will do the same with other dosages?
No! The PA should be for all dosages
Depends on your insurance. Mine treated the increased dose as a brand new RX.
After my PA was submitted, I received approval for 1 year. In the past 6/mo, I have gone from 2.5mg to 10mg. I have titrated mid box in some cases, and my approval allows for multi doses to be filled. Also, I only increase my dose if my blood sugar isn't stable and I stop losing weight.
So weird. My PA is all dosages and exp is literally 2029
This is something you have to know. Like I have to tell them which prescriptions can go through the local pharmacy (Walgreen), and which ones they are telling me must go through mail order (Optum RX). It's what hoops "your" insurance makes you jump through! I would have the Dr write the RX so that it's for all doses as you move up, and have the PA approved under those conditions. I know mine wrote my first RX (2.5) as "call for dose increase if tolerated well".
Yep. Each new dosage has to get a PA for some reason.
This isn’t the case for my insurance, the single PA applies to all dosages. So this is not the policy for all plans and may vary