I know that J&J (they bought Janssen last year) provides payment assistance, have you tried contacting them directly?

Thanks Heather. My PH clinic is prepared to help me with getting the drug somehow. Since I've been taking it for three years and I am still stable they are confident there is a chance.

Jane: That really is stressful. Have you tried checking out all the other D plans using the Medicare tool? If you don't put in your other medications but are careful rto load it as 2026, you should be able to see which plans would actually include Opsumit in their formulary. If any.

Alternatively, the people at Janssen may also know who is including it in their formulary for where you New Mexico.

Last thought is that you should try to get your providers to file for a pre-auth and then immediately file an appeal when it gets turned down.

I'm on Wellcare and I'm taking Wegovy which is not in their formulary. My care team applied 4 times before Wellcare finally approved it for me and my approval letter says valid through 2099. Of course that means I am now committed to Wellcare for the duration.

I wish you luck with this.

Thanks Cindy, ditto!