Kesimpta was denied

Kesimpta was denied

My neurologist and I decided we were going to switch to Kesimpta by my next infusion date. https://multipleexperiences.org/2021/04/26/possibly-switching-to-kesimpta/. My doctor wanted to start the process in July although my next infusion date isn’t until September. We entered the prescription into the pharmacy to start the process. It was less than 24 hours later that I received the denial from my insurance. The denial reason was that this medication wasn’t necessary and there may be other medication that can met my needs, please check with my provider for alternatives. I guess my neurologist was right, this wasn’t going to be an easy transition. Now we have to start the appeal process and that never is easy. Good thing we started 2 months ahead of schedule. I may have a shot of getting this together in time for my next infusion. If not, I’ll have my Rituxan infusion, which I don’t mind. It was the constant aggravation over getting the correct supplies for the infusion that made me crazy. My neurologist felt the change in medication might be warranted now anyway. To both alleviate the constant aggravation and to switch up the way the medication is received. Kesimpta works the same way that Rituxan and Ocrevus does by eliminating the B cells it is just administered monthly by subcutaneous needle as opposed to six month infusion. I don’t think Kesimpta will actually do anything to stop my disease progression better than Rituxan but maybe it will be easier for me in the long run. I guess it won’t matter if I can’t get insurance to approve the switch. I’m once again back to fighting.

2 thoughts on “Kesimpta was denied

  1. My mom is on Kesimpta. She started in December. It’s a lot easier than getting her to the infusion clinic and it does at least eliminate/limit her dizzy spells and vertigo. I don’t believe it’s stopping the disease progression, but my mom is 72 and was diagnosed in 1985. And this medication wasn’t tested on patients over 69, so I’m not sure how much it can do for my mom. However, something is better than nothing. I pray you get approved.

    1. I’ve been on so many medications over the last 23 years I don’t expect miracles from these drugs anymore. I know it will be appealed.
      I’m glad it has helped your mom even a little. That says a lot

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