My insurer wanted me to try a different, older biologic first. My dermatologist recommended going with Taltz instead because
- the eli lily foundation pays for it anyway
- the older biologics have far more serious side effects profiles
Given that, it was kindof a no-brainer. I would have needed to go through the foundation anyway, since the co-pays on these drugs are insane regardless.
However, you may have to fight for it.
https://www.healthcare.gov/appeal-insurance-company-decision...