Kaiser Insurance- Biological drugs

[Anonymous]

I'm in Kaiser NorCal network, and my biologic is covered (not for dermatitis). According to an MD friend in another state, Kaiser covers more biologics than most of her PPO patients' insurance covers.

It would be insane if Kaiser refused to cover any biologic in 2025. You probably need to go to the doctor with your father to figure out what's going on...or maybe you can log into his patient portal and check his records if he'll give you access.

[Anonymous]

Anonymous wrote:I'm in Kaiser NorCal network, and my biologic is covered (not for dermatitis). According to an MD friend in another state, Kaiser covers more biologics than most of her PPO patients' insurance covers.

It would be insane if Kaiser refused to cover any biologic in 2025. You probably need to go to the doctor with your father to figure out what's going on...or maybe you can log into his patient portal and check his records if he'll give you access.

I think we have asked about dupixent but the doctor dissuades him because of side effects (he can’t remember). Googling it the most common “serious” side effect can be dry eye/red eye. Like most drugs there are long tail risks of cancer, increased infection, alien symbiotic bursting from your gut, but realistically I can’t see why he is not letting him at least try it.

[Anonymous]

I doubt that Kaiser has a blanket policy of not covering biologics. However, I can believe that they throw up a lot of roadblocks to getting any medication that is expensive. Years ago, my spouse was on a maintenance prescription that was several hundred dollars per month. The only option Kaiser would give us for filling that script was going in person to their Foggy Bottom location. More recently, Kaiser capped the number of doses of an as-needed medication that I took. My previous insurer approved 16 doses per month, but Kaiser limited me to 10, even though I was running out regularly and this is not a drug of abuse.