$800 A Month?

Michael Fossey, one of the cofounders of Patient Advocate Alliance, had been prescribed several different kinds of statins over the last couple of years to assist with management of cholesterol.  Statins are a class of medication that are highly effective at lowering cholesterol and reduce heart disease risk.  The problem was that Mike was one of a relatively small proportion of the population who is not able to tolerate any of the statin drugs due to severe side effects.

Thankfully there is a new type of cholesterol medication – the Praluent Pen – that can be given as an injection at home every two weeks.  However, it is very expensive as there is no generic.  A Praluent Pen is about $800 per month and predictably, both Medicare and his supplemental insurance rejected it.

We asked the physician to write a letter and we did an appeal explaining the rationale of why this was prescribed for Mike and that it was not just prescribed on a whim… The appeal was successful.  Another success story!