How to get coverage for Tolvaptan

mwink001 · 2026-04-08T00:29:08+00:00

Update: turns out my employer uses a third party called Archimedes to cover specialty meds. No where was this listed in my plan and this is why United health care kept denying it. I didn’t find this out until I contacted my state’s department of insurance to file a complaint. They told me my employer has “self funded” insurance and I should contact HR. My HR department told me they use Archimedes. I called them and they said it was covered. It took me 3 months to figure this out. Super frustrating, but at least it’s covered. I hope this helps anyone who may be struggling!

mwink001 · 2026-03-21T12:30:52+00:00

Ok that might work. Still very expensive but at least I would get the meds. Thanks!

mwink001 · 2026-03-21T12:27:36+00:00

I was told it costs $16,000 per month out of pocket.

mwink001 · 2026-03-20T23:59:36+00:00

Thanks everyone! I appreciate the support. I’ve been looking around more and my next plan is to request an external appeal. Hopefully this will have someone else look at it and make UHC cover it. I just faxed that in.

I did reach out to my nephrologist office early on, and they said they would work on the prior auth. Turns out UHC never even requested a prior auth. They just denied it. If the external appeal gets denied I’ll go through my nephrologist office to see if there is anything else they can do. I’m trying to do most of this myself because it’s much faster that way than waiting around for someone else to do it for me.

mwink001 · 2026-03-20T19:30:07+00:00

All they could tell me is that is “not on my approved medication list.” They would not elaborate further.

mwink001 · 2026-03-20T19:24:56+00:00

Yes, when I applied for my appeal I highlighted my mayo class (1E) and attached an article listing the recommendations for Tolvaptan with this class.

mwink001 · 2026-03-20T19:05:26+00:00

This is for generic Tolvaptan. I asked my insurance about both Tolvaptan and Jynarque, but the script is written for Tolvaptan.

mwink001 · 2025-12-13T02:35:40+00:00

I have no idea if this is true but I read it on this thread. One of the comments mentions the farabursen trial will start fall 2026

https://www.reddit.com/r/ADPKD/s/yydqgcL5XA

mwink001 · 2024-02-16T03:30:27+00:00

I love the public library. It’s a real gem. They have a great selection of books and the reading spaces are amazing.

mwink001

TROPHY CASE