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Top Down

How are all these doctors following the "top down" approach, when the insurance say NO, try something "cheaper" first.

My husband tried to get approved for Entyvio. But he has no symptoms, no diarrhea, no abdominal pain, basically none of the "traditional" crohns symptoms, but yet his fecal is still at 340 (he has TI involvement). He takes LDN, lialda and a bunch of supplements. So, we want something else to bring down his inflammation numbers.

They say, try 6mp first.. So annoyed. It took forever to convince my husband to Entyvio a try and they shoot him down..:ymad:
I am sorry this happened to you. I know that some of the other biologics have support like Remistart for Remicade. I don't know but I am wondering if Entyvio might have a similar program?
I'm sorry you are having ingredients trouble getting entyvio approved. Is it his first biologic? Have you appealed the decision? 340 as an FC result may not be considered high as most people when flaring can have numbers in the 1000s. My son's was 1700 but he was asymptomatic. It may just help to have the GI to keep pushing or provide results from your husbands other testing as well if he has it.

Usually the patient program won't kick in until commercial insurance approves ronroush7
We asked the GI doc if he could appeal it and they acted like we were crazy. Like they didn't do that sort of thing, but they told us WE could all the insurance and "appeal" it. But the insurance basically said, without such and such symptoms, and not having been on an oral suppressant first, they won't approve it. He has psuedopolyps (without ulceration) and narrowing we know for sure, and is pretty much symptom free, except for gurgling. Which, I'm guessing is food trying to get passed the narrowing. I was expecting the GI doc to go to "bat" for us and say his scope looked like this or something.. but ya know what assuming does...