[newtothis31]

I have been on Latuda for over 2 years and it has worked really well since I went down to 40mg.

My employer made some changes to their health insurance, and one of the changes under 2018 is that Latuda is no longer formulary (covered medication under my RX).

I was a wreck when the Pharmacist Technician told me yesterday. I called up my pdoc's office and they advised me they would file an appeal. I am not sure if they were going out of their way to calm me down but they made it sound like they handle these situations on a fairly routine basis.

Has anyone had any experience with this? I am so nervous right now over the possibility of having to change medicine.

[emgreen]

I had this experience with my last AD change (from Lexapro to Trintellix). The pdoc's office was able to work it out with a simple fax. Try not to worry needlessly until you know what the outcome will be. Good luck.

[newtothis31]

Thanks! I just got a call from my doctor's office and they confirmed that everything was good to go. The Pharmacy Tech just needed a prior authorization form. I am so relieved.

[Aviza]

They can get an approval for your med for you, relax. They'll get it done. They deal with this a lot. It's like filing an exception or something. I had it once with a med I was on. Glad to hear it's working well for you, Latuda has been working well for me too.

FYI, in the future... I believe you can appeal multiple times. So even if you get rejected on an appeal, you can still appeal again.

I know sometimes insurance companies want you to prove that there is no similar type of med you could try. (They want you to try cheaper options first, which I suppose is fair.) So if you appeal, they can reject you if they think there is a similar but cheaper med that you didn't try. Then you can appeal again, arguing that you've been taking it for X amount of time and that going off will destabilize you.

So if you get rejected once, you can keep making appeals.

Latuda is a brand name. Does the insurance company accept the generic?

[~Christina]

There is no generic for Latuda at this time.

Gotta love BigPharma, not

Glad they got yours authorized !

[hopeless2015]

Good to hear. They did that to me and did it again when the dose changed.

[Wonderfalls]

Was it not on the formulary at all or was it just in a Tier that meant you paid the whole cost yourself? My insurance used to cover Latuda but not Saphris for some years but then they switched last year to covering Saphris but not Latuda (the Tiers changed--they were still both listed on the formulary). They make a deal with the drug companies each year and apparently Saphris people offered them a better price. My doctor was willing to write a letter but the union through which I get my insurance argued with them and now they cover it for me at $25.

The funny thing, I thought, is they weren't considering just any antipsychotic to be equivalent, but that they had decided that specifically Saphris and Latuda were interchangeable.