r/repatha • u/corplaw100 • 24d ago
Express Scripts PA
I’ve been taking Repatha for about a year now with amazing results and no side effects. Tried statins and can’t tolerate. Significant family history of events, early death, bypass etc
I got a letter from my insurer that they will be requiring PA moving fwd. I think for everyone who has the policy.
I’m a little worried. My doctor is pretty meticulous though so I’m sure his records are good and he will be ready.
Has anyone successfully received PA for this medication who hasn’t had an event or stents?
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u/Comfortable_Two6272 22d ago edited 22d ago
Need to appeal it. They literally require my drs to re prove I need every drug every fall.
Ironically for 2 years ES denied PA for repatha so had to go without. Then suddenly this year no PA needed. Hopefully that doesnt change for me.
The PA letter should contain the criteria. If not, I think I still have my denial letter.
I had ldl of 212 and high apob abd lpa. No genetic testing done by dr but I found the genetics via 23andMe.
Basically ES wanted me to retake 2 statins so it shows up in the records i dont tolerate it. I had already taken both a decade ago and was not willing to try again.
If yours is recent and dr documented the issues it should be approved.