Kaiser Insurance- Biological drugs

[Anonymous]

My father has had years of intense itching all over his body. The diagnosis by his Kaiser doctors diagnosed as atopic dermatitis.

He has tried a slew of steroids, tacrolimus, and UV therapy — nothing has helped.

He does have a mild rash and redness with the itching, a bit more on his scalp. They have ruled out liver problems, but other than that I don’t have much more info. From other thread I will have them check thyroid.

But I want him to try some of the biologic drugs for his condition but he says Kaiser refuses because they are too expensive.

Is this true, an entire class of drugs with completely different mechanisms than steroids are forbidden? He lives in CA so I haven’t been able to go with him to doctor to sort out (my dad didn’t speak English well as he is an immigrant with bad hearing). He is on Medicare at age 80; can he switch the Kaiser part of his health care to something else? I guess they are his Part D — and then under new company have new drugs ?

[Anonymous]

No one has Kaiser?

[Anonymous]

I had Kaiser but never dealt with trying to get drugs they wouldn't provide. Also Kaiser in California is a different organization than Kaiser mid Atlantic.

However California probably has a state advocate for insurance issues, so one option would be to reach out to them for advice. I would not assume that you can't get Kaiser to cover the drugs based on what Kaiser tells you. This is what insurance companies do - they make things hard and hope people will give up, but for people who push they have to give more. We got Kaiser mid Atlantic to pay for out of network treatment because a provider admitted they were not qualified to treat a particular issue and gave us a special phone number to request authorization. They paid for all of the treatment.

[Anonymous]

I live in CA and take a biologic but don’t use HMO’s. The drugs are tens of thousands of dollars. Kaiser is cheap AF. They told someone I know who had debilitating social anxiety to attend an in person group therapy. Single therapy was not an option, attending group therapy online was not an option .

[Anonymous]

Biologics are hard to get for ulcerative colitis and other really serious diseases. I'm sorry your father is going through that, but it's extremely unlikely you'll get coverage for mild itching for something that costs thousands of dollars a month. Has he had allergy testing? Are there other medications he could try? Has he tried switching soap, laundry detergent, and any lotion he uses to something hypoallergenic?

[Anonymous]

Anonymous wrote:Biologics are hard to get for ulcerative colitis and other really serious diseases. I'm sorry your father is going through that, but it's extremely unlikely you'll get coverage for mild itching for something that costs thousands of dollars a month. Has he had allergy testing? Are there other medications he could try? Has he tried switching soap, laundry detergent, and any lotion he uses to something hypoallergenic?

He has tried ALL the things. I have several skin disorders so I’m very familiar with these treatments (and it’s usually the same type of drugs for all conditions).

He has changed all his soap, lotions, laundry. He has UV therapy. A bunch of steroids and the immune suppressant tacrolimus topical. Nothing has helped.

They really don’t give it for UC? That is insane. The drugs cost thousands list price, but voila if you buy cash without insurance a magic coupon appears that brings it down to hundreds of dollars.

[Anonymous]

OP, see if Mark Cuban's drug program carries it and can help.

[Anonymous]

I have psoriasis in a couple areas, not all over.

I tried every cream, steroid, etc. and Zoryve has finally stopped my elbows from itching, cracking and bleeding. It’s really expensive, but I was able to download a manufacturer coupon. I am not sure this is available with Medicare.

I also have a lot of all over itching. I tried every OTC allergy medicine at the suggestion of an allergist. A lot of people rec Zyrtec for skin itching, but I found Claritin D works best for me.

Sorry this is happening to your Dad. All over itching is so uncomfortable. Doctors don’t really seem to take it seriously because they can’t “see” it! I hope your father is able to get some relief.

[Anonymous]

Anonymous wrote:I have psoriasis in a couple areas, not all over.

I tried every cream, steroid, etc. and Zoryve has finally stopped my elbows from itching, cracking and bleeding. It’s really expensive, but I was able to download a manufacturer coupon. I am not sure this is available with Medicare.

I also have a lot of all over itching. I tried every OTC allergy medicine at the suggestion of an allergist. A lot of people rec Zyrtec for skin itching, but I found Claritin D works best for me.

Sorry this is happening to your Dad. All over itching is so uncomfortable. Doctors don’t really seem to take it seriously because they can’t “see” it! I hope your father is able to get some relief.

Zorvye is also very expensive. So hard to get doc to prescribe — we are still trying

[Anonymous]

Anonymous wrote:

Anonymous wrote:I have psoriasis in a couple areas, not all over.

I tried every cream, steroid, etc. and Zoryve has finally stopped my elbows from itching, cracking and bleeding. It’s really expensive, but I was able to download a manufacturer coupon. I am not sure this is available with Medicare.

I also have a lot of all over itching. I tried every OTC allergy medicine at the suggestion of an allergist. A lot of people rec Zyrtec for skin itching, but I found Claritin D works best for me.

Sorry this is happening to your Dad. All over itching is so uncomfortable. Doctors don’t really seem to take it seriously because they can’t “see” it! I hope your father is able to get some relief.

Zorvye is also very expensive. So hard to get doc to prescribe — we are still trying

Im the person in CA who doesn't use Kaiser. My dermatologist prescribed the biological I use AND the Zoryve for my scalp. All for psoriasis.

[Anonymous]

Sigh, and yet people can’t understand why ACA coverage is not affordable without government and tax payer subsidies. This is why.

[Anonymous]

I have had Kaiser. Kaiser is a good, relatively low priced HMO. How do they keep prices down? They do so by deciding which specialists and specialty drugs you NEED, which is not necessarily the same as what you want. You have 3 options - Find a cheaper, but perhaps less idea alternative, pay more for more expansive coverage or pay for this drug out of pocket. Americans want the best of everything, but they don’t want to pay for it, and seem clueless as to why healthcare in this country is so exorbitantly priced. This is why.

[Anonymous]

Anonymous wrote:I have had Kaiser. Kaiser is a good, relatively low priced HMO. How do they keep prices down? They do so by deciding which specialists and specialty drugs you NEED, which is not necessarily the same as what you want. You have 3 options - Find a cheaper, but perhaps less idea alternative, pay more for more expansive coverage or pay for this drug out of pocket. Americans want the best of everything, but they don’t want to pay for it, and seem clueless as to why healthcare in this country is so exorbitantly priced. This is why.

Well no current drugs work, but I guess they won’t die from constant itching, so getting the medicine that may help is not permitted?

[Anonymous]

Not with Kaiser but sharing our experience.

My son has severe eczema and is on Dupixent via Carefirst. Nothing has worked like Dupixent to clear his skin - he used to scratch himself raw until he bled and still scratched more. He was constantly miserable and always seeking relief.

Opzelura is another option. It’s not a biologic but is a topical that works very well. My son did a trial of it before going on Dupixent.

Both Dupixent and Opzelura offer patient assistance programs and my son was able to get a few tubes of Opzelura for free because insurance wouldn’t cover. Dupixent also offers a copay program that pays our RX copay of $100 a month.

[Anonymous]

If they don't approve it first then you can have the doctor write something about medical necessity. I don't have kaiser, but tricare. The doctor has to show proof that we try the cheap stuff first and it hasn't worked. Then I've had luck. But you have to have a doctor who does this for you, and be persistent.