Insurance - Getting Approval for Tafinlar and Mekinist

This will vary greatly according to your insurance company, plan, timing, diagnosis, and so on, but here is my experience briefly.

Tafinlar and Mekinist were approved in July 2022 for all metastatic solid tumor cancers. 

At the end of July, I was advised by my doctor to start them asap, in August. 

My insurance provider denied the prior authorizaion requests initially. Don't be discouraged if that happens. My doctors office said it's common, especially for drugs that are newer. 

My doctor had to write a letter of appeal explaining why I needed that medication and how I qualified. My oncology pharmacist and the medical assistant handled getting to my insurance provider. I did not need to do anything but pray. This took maybe a week in total once we got the denial.

The medications were approved within 72 hours once my insurance provider received the appeal letter. 

The prior authorizaion approval was for 1 year. It is an expensive set of medications at about $27,000 per month. So they do require that you try other treatments first and meet certain requirements. 

The approval required that I use their specialty pharmacy. I was told to call that pharmacy, which I did right away. 

I had the medication mailed and in my hands within a few days after the approval. 

In total it took 2.5 weeks.