Help appealing biologic denials for conditions like RA, Crohn's, and psoriasis.

Appeal Your Biologic Medication Denial

Humira, Skyrizi, Stelara, Entyvio, and others are routinely denied.

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Understanding Your Biologic Medication Denial

Biologics for RA, Crohn's, psoriasis and more are often denied for step therapy or "insufficient severity."

Common Reasons for Denial

! Must try cheaper medications first
! Condition not severe enough
! Off-label use not covered

How We Help

We help you articulate clinical severity, treatment failures, diagnostic evidence, and medical rationale that insurers need to see.

Start your biologic appeal.

Some Types of Evidence We Can Use For Supporting Your Appeal

✓ Professional guidelines include biologics as treatment options for various autoimmune conditions when prescribed by a specialist.

✓ Your rheumatologist, gastroenterologist, or dermatologist's treatment plan is key evidence for your appeal.

✓ Documentation of prior treatment attempts and their outcomes strengthens appeals for biologic coverage.

While You're Fighting Your Denial

Talk to your provider about these options that might help bridge the gap:

→ While fighting your denial, ask your provider about biosimilar options which may have different coverage status.

→ Some conditions may respond to conventional DMARDs (like methotrexate) as a bridge while appealing.

→ Different biologics with similar mechanisms may have better formulary status with your insurer.

Patient Assistance & Copay Programs

These programs may help reduce your costs while you appeal:

myAbbVie Assist (Humira, Skyrizi, Rinvoq)

Free medication for qualifying uninsured/underinsured patients. Income limits apply.

HUMIRA Complete Savings Card

Commercially insured patients may pay as little as $0/month. Not for government insurance.

Skyrizi Complete Savings Card

Eligible commercially insured patients may pay as little as $0 per dose. Max $14,000/year benefit.

Janssen CarePath (Stelara)

Eligible patients pay $5 per dose with commercial insurance. Patient assistance also available.

EntyvioConnect (Entyvio)

Eligible patients may pay as little as $5 per dose. Max $20,000/year benefit for commercial insurance.

COSENTYX Connect

84% of eligible patients paid $0 out of pocket. Up to 2 years free while appealing denials.

Enbrel Co-Pay Program

Eligible commercially insured patients may pay as little as $0 per dose.

Eligibility requirements and program terms may change. Please verify current details directly with each organization.

Patient Advocacy & Support Organizations

These organizations provide education, support, and advocacy for patients:

Global Healthy Living Foundation

Patient advocacy for chronic disease including biologic medication access.

Frequently Asked Questions

Step therapy means the insurer wants you to fail cheaper drugs first. Your appeal can show that you've already tried and failed them, or that they're unsafe or inappropriate for you.

Some off-label uses are still supported by strong evidence. Your appeal can cite studies and guidelines that support the prescription.

Yes, ideally. A short letter from your specialist explaining why this biologic is necessary can make a big difference.

Ready to Fight Your Biologic Medication Denial?

Our free AI-powered tool will help you generate a compelling appeal letter in minutes.

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Disclaimer: Fight Health Insurance is not affiliated with, endorsed by, or partnered with any pharmaceutical manufacturer, healthcare provider, medical device company, or patient assistance program. All information provided is for educational and informational purposes only and does not constitute medical or legal advice. Please consult with your healthcare provider regarding treatment options and with your insurance company regarding coverage decisions.