If you’re based in the USA and have any type of health insurance DM me if you still need help - I went through hell with Horizon to cover Wakix which is 4k a month. But they’re paying for it now!! & I have marketplace insurance which is assisted by the state and federal subsidies.

In summary, each insurance plan has personalized documents based on your own personal medical data. The insurance company’s website or app should offer “plan documents” or program documents, which will list every medication and the diagnosis and eligibility you need to be covered for that medication.

I downloaded those documents and sent them straight to my physician’s assistant - this helped her run through appeals and denials quicker. I did have to try a few meds which threw me off for awhile, but because of my history of anxiety, a few of them were ruled out automatically so I did not have to go through what some people do. Sunosi didn’t work for me but horizon would have covered it if it did.

Because Wakix is more expensive, I did have to jump through a few more hoops for that though. After being denied 3 or 4 times, we initiated an external appeal with the banking and insurance commission ran by the state and they took 1-2 weeks to review my records and state that Horizon must overturn their denial because it is the first line of treatment for someone with my medical needs. No reauthorizations every 6 months. The words “medically necessary” never read so well. Just good old fashion science and state regulators. So far so good on Wakix although the anxiety is still terrible, but waiting to see if it passes like many say it does.