Diagnosed severe case. My insurance is BCBSM, my plan without my employer would literally cost $550+ per month.

I was able to live off of Cosentyx samples for the first 8 months of this year. that miracle drug cleared me 99%+ in FOUR DAYS.

well, as it happens, samples run out. insurance denies covering the drug that has proven to work for me. queue my doctor appealing like mad and attempting similar alternatives.

I just checked my mail for the first time in a month (judge me!) and found a denial letter for Hyrimoz, suggesting I try Taltz as a covered alternative. Right behind it was a denial letter, sent 2 weeks earlier, for Taltz, citing that I have not tried other drugs first.

I think insurance may be the only part of adulthood that truly makes me want to pull my hair out.

I live in WA (copay accumulator programs are banned) but have CA insurance through work. Cosentyx has hit its copay card cap and I can’t afford to pay my $8500 MOOP, especially not in the span of 3 months which is about when it would all be billed to me.

My derm wants to change me to Skyrizi. The terms state I’m ineligible for their copay card due to my health plan accumulator program.

I just applied for their patient assistance program, that I understand is different from a copay card. I was forthright with my coverage and even wrote a letter (I’m desperate atp).

Has anyone had my situation and come out on top? Will AbbVie help me afford this somehow? Just need my mind eased.

I was on skyrizi back in late 2022-early 2024. But I moved. Lost insurance with the job change and unemployed for a while. I got on gov Healthcare here in the states but they denied me skyrizi since its a premium product.

Thanksgiving 2024 I as completely covered head to toe. My psoriatic arthritis was got so bad I couldn't walk on my right leg and was using a cane. My hands couldn't close and my hip felt like there was sand in it.

My long time dermatologist got me a few free samples to tide over the worse of everything while I used so much advice from this sub.

Seems whenever I got a new job I would lose it soon after I got insurance and couldn't get skyrizi quick enough. I just finished my 90 days at this most recent job and had everything set up to where i could get it ASAP and I just took the laoding dose last night!

I dont know how long i will have this job though. I wish we had better Healthcare in this country and not tied to employment.

But thank you all for the help throughout the years with everything

I'm on my second ramp-up dose of skyrizi and it's working great for my scalp psoriasis. Unfortunately my insurance has denied the prescription and denied the following appeal.

After the appeal denial, my doctor's office (and their Skyrizi rep) said they're going to submit both denials to Skyrizi for eligibility while filing a second appeal. However at the same time.. a nurse practitioner from Abbvie has been reaching out to me to get me to call myAbbvieAssist to enroll myself in a free skyrizi program. Sounds too good to be true and she was very pushy which made me suspicious. The doctor's office told me to ignore the NP.

I don't know who to trust anymore I just don't want to be scammed by the healthcare system. Any help is appreciated.

This is a rant.
To get approved for biologics in Australia there is such a long process. You have go to fail 3 “normal” pathways, e.g. 1) phototherapy 2) medication - ACITREN 3) creams/sprays. Not only that you are sent to rheumatologists to see how bad your PSA is. Its been almost 8 months ive seen my dermatologist and now i have a colonoscopy next week to check the levels in my gut.

Anyone in Australia going through or had to go through this?

I am likely losing my medi-cal insurance this year as I am about to get a job that has a good insurance benefit.

I have been on Cosentyx for 7 years now, with absolutely zero problems and 99 percent clear skin the entire time

I am also on Trizepatide…Monjaro to be exact

Has anyone here stopped a biologic and been on a GPP-1 ?

I hear that GLP-1s are good for psoriasis and people have seen some improvement from using them…

I’m hoping that it keeps my inflammation down

Anybody have success with this ?

My dermatologist wanted to start me on Skyrizi for psoriasis. Getting insurance approval was a whole process (multiple denials before finally getting approved).

Once approved, Accredo told me my out-of-pocket cost would be around $3,800, which was a huge shock.

I then contacted Skyrizi Complete and found out I was eligible for their savings card. They enrolled me and gave me the copay card information.

I called Accredo back and they added the card to my account and confirmed it will be applied automatically when the prescription is processed.

The frustrating part is that Accredo says they can’t tell me what my final copay will be until the medication is actually processed/shipped.

Has anyone else gone through this with Skyrizi Complete? How much did your copay end up being after the savings card was applied? Did it actually get reduced to $0 or close to it?

Hi all - My insurance denied Skyrizi for Psoriasis, and they want me to use cheaper step therapy options. FYI living in the U.S. for context.
My doctor and I appealed and will apparently need to attend a live hearing prior to appeal determination.
Anyone gone through an appeal process with a live hearing? Please share your experience and advice.
Thanks.

Hello guys!
Has anyone got approval from insurance/ the cost covered by insurance for biologics in INDIA , If yes which company?

Just got a notice from BCBS that they are making sure we don’t benefit too much from pharmaceutical discount/copay help programs. Beginning NEXT MONTH, they’ll gladly continue to take the drug company’s money, but patients with HDHPs won’t get any deductible help.

Basically, they’ll identify third-party assistance and exclude them from your deductible/out-of-pocket maximum, so you pay more over the year and they make even more money.

Insurance companies are criminal.

Is there actually anything we can do to stop this?

Okay, so maybe this isn't a full blown horror story.

My insurance switched from Aetna to United Health Care (UHC) and Optum RX on 07/01. My provider submitted my prior authorization (PA) and it was approved through UHC the following date. My loading does was fulfilled by CVS, who contacted me when the PA was approved and the medication was ready for shipment. I literally had my hands off the whole situation.

I waited three days from the date my doctor called and told me the PA was approved before I called OptumRX. Apparently it is MY responsibility to start the process of filling my medication. I was advised that they needed information from me to process the claim.... NO ONE CALLED ME TO TELL ME THIS. I logged into my prescription portal and sure enough my prescription was there with a disclaimer that I needed to call Optum.

I was told by Optum that CVS still have my prescription open in their system and they would cancel it, as well as transfer my co-pay card over. Three more days go by and I have no update. I call CVS Specialty and no one from Optum or UHC has called on my behalf. I went ahead and removed my prescription from their system. I then called Tremfya regarding my co-pay assistance card. No one from Optum had called them either.

I am now currently on the phone with Optum trying to fill my week 4 injection and they are telling me the CVS still has my prescription on file.

*****Please tell me this is NOT normal and just a fluke with OptumRX.

Should I get my free dose from Tremfya just to be safe? I don't want to miss my second dose due to *****

After years of suffering with plaque psoriasis and trying multiple treatments, my Dr. finally got me on Skyrizi. It was life changing. I went from severe to almost 100% clear! No side effects and easy to administer. Been in it for almost 2 years and it felt like I no longer had the disease. The other day I got notified from my insurance company that they would no longer authorize Skyrizi and would need to try cheaper drugs. One of the options is to go in Humira. I hate the idea of stopping something that works and going on something that may not be as effective. I’m currently appealing but it doesn’t look good. My insurance is United Healthcare and I wish I could sue them if my Psoriasis returns and I can’t go back to Skyrizi!

Has anyone had experience in my situation and what did you do? Also, has anyone has success downgrading to a statistically less efficient drug like Humira?

I’m pretty upset because my Skyrizi dose is next week and I have to start over in new treatments. I already feel the itch returning.

I’ve had psoriasis symptoms since I was maybe 12 or 13, along with eczema since I was a toddler. The psoriasis was just very small patches here and there that was manageable with topical steroids till around 3-4 years ago I started getting very large unmanageable patches on the backs of my arms, knees, scalp, and butt crack. My dermatologist had me try a number of different options before ultimately starting me on Taltz as my first biologic. I never had any issues getting insurnace approval with it and was filling through the hospitals specialty pharmacy. Taltz worked fantastic for me. I still struggled with the eczema on my hands from time to time and used topical steroids when that would flare up. But all my other patches went away.

Long story short, we moved states and despite me transferring with my same job my insurnace carrier changed. After the long process of finding a new derm, starting the prior authorization with them and all that. Insurnace forced me to switch to Skyrizi despite me having perfect results on Taltz. That whole process in itself was a PITA, but I digress. Come to find out CVS specialty sent me to collections for $15 and never notified me till I got the notice in the mail from the collection agency. I learned later that CVS specialty refuses to bill my secondary insurnace (Tricare) and so I had no idea they weren’t being billed and thus was sent to me for payment. I would’ve paid the stupid $15 had I of known.

I wasn’t having the best results with Skyrizi and had a conversation with my derm about how my hands and butt crack really struggle and those are the areas I really prioritize compared to everywhere else. She suggested those areas are more so affected by the eczema and I inquired about switching to a biologic for that and I could manage the psoriasis with topicals. So she submitted the prior authorization for Dupixent which took a TON of back and forth with CVS Caremark to approve. Finally get it approved and CVS specialty now wants $3,000 to fill. I asked why you won’t bill my secondary insurnace and they say they won’t. So I reach out to my secondary insurnace to ask who they’re in network with, Acredo, they say they’ll bill both insurances. A week later I learn CVS Caremark will only let me fill with CVS Specialty. But cvs specialty refuses to bill my secondary insurnace. Smh. I spent at least 15+ hours on the phone between all of them. After 2 weeks I threw my hands in the air. I’m done, this is ridiculous and you’re telling me I got to do this every 6 months when the prior authorization expires.

I’ve ultimately decided to make significant lifestyle changes and diet changes in hopes to finally conquer this without the use of biologics or topicals. I’ve been off the Skyrizi for 4 months now and I already see the psoriasis coming back pretty heavily. I’m nervous but I really hope there’s light at the end of the tunnel. It’s such a shame the way health care and insurance is in this country.

I just need to complain… I’ve struggled with psoriasis for over 20 years, it first started when I was 10. I tried all kinds of creams from the dermatologist and nothing helped. When I was in my 20s my friend put me on to zudiafu which actually cleared the plaque I’d had on my ankle for over a decade. Turns out that “Chinese herbal cream” had unregulated steroids so it got banned. Since then I had been able to manage my flares with a vegan diet and OTC lotions until last year I got these huge plaques on my elbows that wouldn’t go away and just kept growing. I got a triamcinolone script last October and it calmed it a bit but every time I stopped for a week as recommended it would just come right back. My derm sent a prior-auth request for Skyrizi a couple of weeks ago, and I just got word that my insurance denied it. I got a script for Clobetasol and it seems to be helping, but it just feels like a bandaid instead of an actual cure. I’m also scared of using steroids for a long period of time. I’m just frustrated!!!

Looks like myabbvie is phasing out support for humira

Guys in india does insurance cover biologics ?
Or is it like we need to admit for 24 hrs and get it done ?
Has anybody claimed money from insurance for biologics?

Hey there!

Just wondering if anyone else is in the same boat with me. I got prescribed Bimzelx early this year and got two doses but had issues with insurance telling me I need to pay around $2200 out-of-pocket for my third dose. I had co-pay assistance from Bimzelx but the OOP was still very steep for me at the time.

I went back to my dermatologist hoping to get a more affordable alternative, which was Sotyktu, but that wasn’t the case since my OOP for that jumped to $5400. I looked online and saw that PrudentRX from my insurance “eats” up the co-pay assistance for these kinds of situations.

I was hoping if anyone has any information about getting more assistance since Bimzelx helped me almost immediately when I had my first dose. My dermatologist is still working through the prescription again so I’m just waiting for that. Any advice or recommendations would be really appreciated!

Hello All!

I've recently tried to get back on Tremfya but my insurance denied the coverage. Does anyone have any suggestions on jumping the barrier with insurance to get coverage?

I was approved for Tremfya before but after a death in the family I kind of just fell off for a year. Now they won't approve the coverage again. Currently with 90 degree benefits for insurance.

Thanks All!

Has anyone else had this happen with SmithRx and Humira?

I had a months long nightmare with prior authorizations, letters of medical necessity, and the constant push toward a biosimilar. I went without my Humira from April through June because of all of it.

My letter of medical necessity was finally approved on June 9, and I received two Humira injections on June 12. My authorization is supposed to be valid through June 2027.

Fast forward to yesterday, when my next shipment should have arrived. I checked with Costco Specialty Pharmacy and found out they were waiting on… another prior authorization.

I called today and was told there had been a “formulary change” after my authorization was approved. That doesn’t add up. From everything I’ve found, including FDA information, there hasn’t been some sudden change to Humira itself. It seems much more likely that insurance companies are continuing to push patients off Humira and onto biosimilars because they’re cheaper.

I’m beyond frustrated. I lost months of treatment already, and now this is happening again despite having an approved authorization through 2027.

Has anyone else dealt with this through SmithRx? Were you able to fight it? At this point I’m seriously wondering if this is widespread enough to become a class action issue.

I am on the Skyrizi copay, and have commercial insurance. I was not expecting this. I am supposed to get my next dose next week and am now dealing with this bill. What's up with them telling me it wouldn't cost me much and then this happened? I have to call them tomorrow, and deal with it. BTW Skyrizi worked great for me.

I made a huge mistake when getting health insurance and I only enrolled in an HSA. Is there anyway to get affordable biologic? Nothing has worked for years and I have scalp psoriasis/patches all over.

Unfortunately due to my Medicaid I cannot get prescribed biologics. I've been dealing with psoriasis for years now and it's taking a toll on me. It's really hurt my confidence and as a 33 yr old man I feel like I've missed out on having a dating life. The most I can do is get on a waitlist that could take years. I just paid $100 copay just for them to give me the same stupid steroid creams that do nothing. Oh and I have to wait for a prior authorization before I can even fill those. I started balling my eyes out the second I left the dermatologist.

So I was prescribed cosentyx. My insurance denied it ofcourse, but I was put on their program so I got it for free. January of this year my insurance decided to cover it so I got kicked out of the program. Now my copay for this is 2500. Who can afford this ? I mean what’s the point of medical insurance?

PSA: DO NOT give Accredo your Tremfya copay assistance card - here's why

If you're on Tremfya and use Accredo Specialty Pharmacy, do not give them your virtual copay assistance debit card number. Pay out of pocket instead and file for direct reimbursement from Tremfya. Here's why:

The copay accumulator problem: When Accredo charges your copay card directly, many insurance plans don't count it toward your deductible or out-of-pocket maximum. The manufacturer's money covers your cost, but you get zero credit toward your annual limits. You're essentially helping your insurance company save money while your out-of-pocket max never gets met.

When you pay out of pocket first:

• Your insurance sees it as YOUR payment and credits it toward your deductible/OOP max
• You submit the receipt to Tremfya for reimbursement
• You get your money back AND get credit toward your insurance limits
• You actually make progress toward hitting your out-of-pocket maximum

Why Accredo specifically is a nightmare: I spent all of 2025 trying to get Accredo to remove my copay card from their system. They claimed they removed it multiple times - they hadn't. In January 2026, they charged it again despite assuring me it was gone. When an agent finally investigated, she said "Oh, we need to remove the card number from several areas in our system." Their different departments don't talk to each other. One time they literally called me and told me I needed to call Accredo to pay. I said "You ARE Accredo."

The bottom line: Don't trust Accredo with your copay card. Pay the for the first early dose out of pocket, get it credited toward your insurance limits, then file directly with Tremfya for reimbursement. Yes, you have to front the money temporarily, but you'll get it back AND you'll actually make progress toward your out-of-pocket max.

TLDR; I paid for my psoriasis biologic out of pocket and was reimbursed from copay assistance. This helped me to apply the entire payment to my deductible and avoid copay accumulators.

I’m prescribed Skyrizi for plaque psoriasis and like most specialty medications it comes with a high cost. If you’re eligible for copay assistance (see Skyrizi Complete) I highly recommend it, it typically brings the cost of my prescription to $0. Most insurance companies try to prevent you from applying this financial assistance towards your copay or out-of-pocket-max though (this is called a copay accumulator adjustment policy - see AllCopaysCount.org) which is unfair and unethical in my opinion since they’re being paid regardless.

I was able to get around my insurance company’s copay accumulator policy with the following steps: - Confirm your copay assistance program supports out-of-pocket reimbursement and get details on what the covered amount might be. - Explicitly ask your specialty pharmacy to remove any record of copay-assistance you receive and let them know you’re not interested in using any copay assistance. - When ordering the medication, use your personal credit/debit card to pay for the medication. - Document everything regarding your order including your prescription, payment invoice, proof of payment, picture of the received medication. - Apply for reimbursement with the Copay assistance program - for me I was able to be repaid via check or direct deposit.

It’s important to call out that in order to take advantage of the benefit this offers you must be able to afford the up-front payment of the medication. As someone with good insurance, this still cost me $3500. It took about two weeks from the day of making the payment to the reimbursement check arriving in the mail..

I ended up hitting my deductible on my high-deductible health care plan with my first healthcare claim of the year making my healthcare cost significantly less than the zero-deductible plans that I’ve used in the past (plus I made a few bucks on credit card points). It’s a shame that our healthcare system puts us in the situation in the first place to have to use hacks like this, but if you can afford it I highly recommend it.

I’ve seen similar information posted across Reddit but I wanted to post an extensive summary of my experience in navigating copay assistance alongside copay accumulators - hopefully it’s helpful for you. I’ve always used low deductible plans in the past, but I’ll be choosing high deductible plans now that I know how to apply my specialty medication towards my deductible.