Most insurances are currently pushing back on higher dosing or higher frequency of biologics.
Jansen typically helps cover the copay difference if your insurance approves the drug but not if you have commercial insurance that denied it at a higher dose or frequency
We are currently fighting this one for Stelara
Same issue after years of higher frequency
Insurance refuses to cover higher frequency
But will cover the drug at lower frequency
Docs office has to appeal -typically twice
First appeal is paper records
Second appeal is better if they can do “peer to peer” -phone call with an insurance doc
If those are both denied then you can get an independent review by a third party
This should all be spelled out in the denial letter recieved by the parents
Request a case manager through the insurance to help
Second option is see the social worker through the hospital -they can help expedite application to medical assistance-state insurance
They cover kids with crohns under 18 regardless of parents income -
It acts as a secondary insurance
That would be a long shot for them to cover it at the higher dose given the primary denied it
But worth trying
Once you have commercial insurance deny it
It’s very hard to get other options to help you cover it
Non for profit helps really have restrictions to get help to those who have no insurance
Commercial insurance is not permitted typically